Bronchial Atresia Associated With a Giant Subpleural Bulla: A Case Report

Bronchial atresia is a rare congenital malformation characterized by focal interruption of a lobar, segmental, or subsegmental bronchus, with distal mucus impaction and hyperinflation of the affected lung.It is usually asymptomatic and detected incidentally.We report the case of a 25-year-old man with no relevant medical history who presented to primary care with a three-day history of productive cough, rhinorrhea, nasal congestion, and myalgia.Physical examination revealed hyperresonance to percussion and markedly diminished breath sounds throughout the left hemithorax.Chest radiography showed marked left-sided hyperlucency with contralateral mediastinal shift.Chest computed tomography demonstrated a focal abnormality of the left upper lobe bronchus with distal mucus-filled bronchial dilatation consistent with a bronchocele, together with a giant subpleural bulla measuring approximately 25 cm along its longest axis and occupying about half of the left hemithorax.After multidisciplinary assessment, elective video-assisted thoracoscopic resection of the bulla was performed.The procedure was complicated by an iatrogenic laceration of the descending aorta during division of the inferior pulmonary ligament, causing major arterial hemorrhage and requiring emergent conversion to thoracotomy and direct aortic repair.The postoperative course was complicated by left pleural empyema, which was successfully treated with antibiotics and drainage.At three months, the patient reported only mild exertional dyspnea, with no recurrent respiratory infection or pneumothorax and satisfactory radiographic re-expansion of the remaining left lung.This case highlights an uncommon association between bronchial atresia and extensive bullous disease, the value of careful assessment of disproportionate physical findings, and the importance of individualized surgical planning when marked intrathoracic anatomical distortion is present.