A physiologic assessment of segmental bronchial atresia

A child with congenital atresia of the apical posterior bronchus was followed from birth. The obstructed segment, ventilated through collateral pathways, was documented to be aerated by day 6. At 10 yr of age, the anomalous and adjacent normal segments were resected because of respiratory symptoms. Preoperatively, pulmonary function studies showed a mild obstructive ventilatory defect. Postoperatively, although asymptomatic, the patient's obstruction persisted. Collateral resistance (Rcoll) measured between the atretic and adjacent normal segments of the resected lung was comparable to Rcoll in young adults, but markedly greater than Rcoll for emphysematous lungs. Pathologic examination revealed gross emphysematous changes in the anomalous segment. We conclude that collateral pathways exist early in life and that ventilation of lung distal to congenitally absent airways is slow and may contribute to the development of emphysema; we speculate that this lesion should be resected early in life to permit optimal growth and development of the remaining lung.