Bronchial Coarctation Considerations

Case Report of Bronchial Coarctation is published here.

Chevalier Jackson, describing lesions he observed through a bronchoscope, noted that a few patients with asthma had “organic stenosis of the bronchi.” He felt that in children some of the lesions were congenital, whereas in adults, they were “fibrotic” and could be treated by dilation. It is unlikely that our patient has asthma since she did not improve significantly after treatment with 40 mg of prednisone a day for eight weeks. Other than Jackson’s report, we have not been able to find descriptions of similar lesions in the bronchoscopic literature. The authors of this report have performed over 12,000 bronchoscopies and have not seen similar lesions.

Chronic Bronchitis

Freimanis and Molnar reviewed 2,000 bronchograms in patients they said had chronic bronchitis and emphysema (they did not define chronic bronchitis though) and noted that some had a “spastic segment” of variable length, occasionally localized to a short area. They showed bronchograms of one patient who had a narrow right middle lobe bronchus that dilated after isoproterenol administration and inferred that the lesion was reversible. The bronchographic appearance was similar to our patients findings, although our patient’s lesion was not reversible.

Simon and Galbraith have described generalized narrowing distal to the third or fourth generation of bronchi in four of 90 patients they said had chronic bronchitis (they also did not define chronic bronchitis). The lesions in our patient are more proximal than the lesions they described, occurring in the early portions of the third and fourth order bronchi. They noted that in none of their four patients was the bronchospasm severe. In contrast, the lesions in the left lower lobe and right upper lobe of our patient were severe.

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We believe the stenotic lesions in our patient represent a congenital abnormality. The patient was asymptomatic until she developed concomitant chronic bronchitis which further narrowed her bronchi. Further reports of similar lesions in other patients will be necessary, however, to determine the exact role of chronic bronchitis in the genesis of this disorder.