PMC9763669_01
(A) Chest X-ray at presentation (B) Chest X-ray after ablation.
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Chest X-ray showed an overall small right lung with persistent RML and RLL atelectasis and mediastinal shift to the right (Fig. 1-A). Chest x-ray showed re-expansion of the right lower and middle lobes, but the fully expanded right lung continued to appear small (hypoplastic) compared to the left lung (Fig. 1-B).
(A) Chest Computed Tomography - Transverse section(Red arrow shows bronchial web) (B) Chest Computed Tomography - Transverse section showing right lobar collapse (C) Chest Computed Tomography - Coronal section (D) Chest Computed Tomography - Three-dimensional image of the airways. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Chest computed tomography (CT) with contrast showed atelectasis and traction bronchiectasis involving RML and RLL with hypoplastic right pulmonary artery (RPA) (Fig. 2-A, B, C and D).
(A) Spirometry at presentation (B) Spirometry after one-month follow-up post ablation.
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Spirometry showed flattening of the expiratory phase of the flow volume loop consistent with intrathoracic large airway obstruction pattern (Fig. 3-A). Post-procedure spirometry revealed significant improvement in forced expiratory volume in 1 second (FEV1%) by 540 ml and forced vital capacity (FVC) by 520 ml compared to pre-procedure spirometry (Fig. 3-B and Fig. 5).
(A) Flexible bronchoscopy view showing the bronchial web at the take-off of right main-stem bronchus (B) Flexible bronchoscopy view post ablation and dilation of the bronchial web.
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Diagnostic flexible bronchoscopy was then performed, which revealed a thin fibrovascular membrane occluding the lumen of the right main bronchus except for a tiny opening (about 2 mm) at its periphery (Fig. 4-A). APC ablation and dilatation resulted in near-complete resolution of the obstruction with a remnant edge (Fig. 4-B).