A rare bronchial anomaly presenting as a paracardiac mass

Area of Science:

• Thoracic medicine
• Pulmonary radiology
• Anatomical variations

Background:

• Abnormal bronchi originating from the trachea or main bronchi are uncommon and often asymptomatic.
• These bronchial variations present diagnostic challenges due to variable clinical presentations and limited clinician awareness.
• Delayed diagnosis can lead to serious complications such as recurrent infections, hemoptysis, and malignancies.

Purpose of the Study:

• To highlight the diagnostic challenges posed by rare bronchial anomalies.
• To emphasize the utility of multidetector computed tomography (MDCT) in identifying such variations.
• To underscore the importance of thorough airway evaluation in patients with persistent respiratory symptoms.

Main Methods:

• Case report of a patient presenting with chronic cough.
• Initial diagnostic workup included endoscopic evaluation and fine-needle aspiration cytology (FNAC), which were non-diagnostic.
• Definitive diagnosis was established through detailed review of multidetector computed tomography (MDCT) imaging.

Main Results:

• MDCT revealed an accessory cardiac bronchus with rudimentary lung parenchyma in the paracardiac region.
• This finding explained the patient's chronic cough, which was previously undiagnosed.
• The case illustrates a rare congenital airway anomaly.

Conclusions:

• Accessory cardiac bronchus is a rare bronchial variation requiring high index of suspicion.
• Meticulous airway assessment using MDCT is essential for diagnosing subtle bronchial anomalies.
• Early identification of these variations can prevent significant respiratory complications.