Unsuspected case of congenital bronchial atresia in workup for supposed pulmonary AVM

A 58-year-old man was send to our hospital for embolisation of an arteriovenous (AV) malformation of the right lung. This diagnosis was based on a CT made in the referring hospital. Diagnostic pulmonary angiography with catheter placed in the right main pulmonary artery (Fig. A) did not show an AV-malformation. Nevertheless striking was the diminished number of pulmonary vessels in the superior and middle part of the right lung (arrows). When revising the CT scan a hypodense mass was seen in the right hilum (Fig. B, arrow). This lesion was not vascularised and was located near the right upper lobe bronchus (Fig. C, arrow). The lung segment distal to this mass contained little vessels. These findings are compatible with bronchial atresia. Retrospectively this congenital anomaly could already be suggested based on the chest X-ray (Fig. D), which showed a perihilar mass (short arrow) and decreased vascular marking of the right peripheral lung zones (arrows).