A case of congenital bronchial atresia complaining of chest pain with anomalous pulmonary venous drainage

A 21-year-old male was admitted to Chiba University Hospital because of chest pain on heavy exercise and an abnormal shadow on chest X-ray film. The chest film showed a nodular shadow located near the left hilum and marked hyperlucency in the left upper lung filed. These findings on chest film had existed for 13 years with gradual progression of the hyperlucent field. The nodular shadow appeared to be located in left S1 + 2 but bronchographic examination revealed that this abnormal shadow was independent of the branches of B1 + 2. Delays of imaging and washout in the ventilation scintigram with 133Xe gas and perfusion defect in the pulmonary perfusion scintigram with 133Xe were found in the left upper lung field. The patient was diagnosed as congenital bronchial atresia based on the evidence of special features on chest X-ray film and pulmonary ventilation/perfusion scintigrams. Furthermore, it was revealed by pulmonary venography that the left upper pulmonary vein entered the left brachiocephalic vein. Left upper lobectomy was carried out because of his complaint of chest pain on exertion and the compression of the left lower lobe by the overinflating lung. We discussed the cause of and relationship between congenital bronchial atresia and anomalous pulmonary venous drainage.