Bronchopulmonary<unk>  (BPS) is a rare congenital malformation of the lower respiratory tract. It consists of a nonfunctioning mass of normal lung tissue that lacks normal communication with the tracheobronchial tree, and that receives its arterial blood supply from the systemic circulation. BPS is estimated to comprise one to six percent of all congenital pulmonary malformations, making it an extremely rare disorder.<unk> s are classified anatomically. Intralobar<unk>  in which the lesion is located within a normal lobe and lacks its own visceral pleura. Extralobar<unk>  in which the mass is located outside the normal lung and has its own visceral pleuraThe blood supply of 75% of<unk> s is derived from the thoracic or abdominal aorta. The remaining 25% of<unk> s receive their blood flow from the subclavian, intercostal, pulmonary, pericardiophrenic, innominate, internal mammary, celiac, splenic, or renal arteries. Types Intralobar<unk>  * The intralobar variety accounts for 75 percent of all<unk> s. * Usually presents in adolescence or adulthood as recurrent pneumonias. * The lung tissue lies within the same visceral pleura as the lobe in which it occurs. * Males and females are equally affected. * The arterial supply is usually derived from the lower thoracic or upper abdominal aorta. * Venous drainage is usually to the left atrium via pulmonary veins establishing a left to left shunt. * Abnormal connections to the vena cava, azygous vein, or right atrium may occur. * Two thirds of the time, the<unk>  is located in the paravertebral gutter in the posterior segment of the left lower lobe. * Unlike extralobar<unk> , it is rarely associated with other developmental abnormalities. * Patients present with signs and symptoms of pulmonary infection of a lower lobe mass. * It is believed that<unk> s become infected when bacteria migrate through the Pores of Kohn or if the<unk>  is incomplete. Extralobar<unk>  * The extralobar variety accounts for 25 percent of all<unk> s. * Onset usually in infancy with respiratory compromise. * Develops as an accessory lung contained within its own pleura. * Male to female predominance of 3:1 to 4:1. * Related to the left hemidiaphragm in 90% of cases. * May present as a subdiaphragmatic or retroperitoneal mass. * In general, the arterial supply of comes from an aberrant vessel from thoracic aorta. * It usually drains via the systemic venous system to the right atrium, vena cava, or azygous systems. * Congenital anomalies occur more frequently in patients with extralobar<unk>  the intralobar<unk> . * Associated anomalies include Congenital cystic adenomatoid malformation, congenital diaphragmatic hernia, vertebral anomalies, congenital heart disease, pulmonary hypoplasia, and colonic duplication * Since it is enveloped in its own pleural sac, it rarely gets infected so almost always presents as a homogeneous soft tissue mass. * The mass may be closely associated with the esophagus, and fistulae may develop. Imaging * An arteriogram has been considered vital in documenting the systemic blood supply, allowing definitive diagnosis as well as preoperative planning. * The advent of new noninvasive imaging techniques has changed this thinking. Chest radiograph *<unk> s typically appear as a uniformly dense mass within the thoracic cavity or pulmonary parenchyma. * Recurrent infection can lead to the development of cystic areas within the mass. * Air-fluid levels due to bronchial communication can be seen. Ultrasound * The typical sonographic appearance of BPS is an echogenic homogeneous mass that may be well defined or irregular. * Some lesions have a cystic or more complex appearance. * Doppler studies are helpful to identify the characteristic aberrant systemic artery that arises from the aorta and to delineate venous drainage. CT Chest CT showing<unk>  * CT scans have 90% accuracy in the diagnosis of<unk> . * The most common appearance is a solid mass that may be homogeneous or heterogeneous, sometimes with cystic changes. * Less frequent findings include a large cavitary lesion with an air-fluid level, a collection of many small cystic lesions containing air or fluid, or a well-defined cystic mass. * Emphysematous changes at the margin of the lesion are characteristic and may not be visible on the chest radiograph. * CT technique for optimal depiction of lesions by using state-of-the-art volumetric scanning requires a fast intravenous (IV) contrast injection rate and appropriate volume and delay based upon size. * Multiplanar and 3D reconstructions are helpful. MRI * Contrast-enhanced MRA or even conventional T1-weighted spin-echo (SE) images may help in the diagnosis of<unk>  by demonstrating a systemic blood supply, particularly from the aorta, to a basal lung mass. * In addition, MRA may demonstrate venous drainage of the mass and may obviate more invasive investigations. * However, CT allows sharper delineation of thin-walled cysts and emphysematous changes than MRI.
Pulmonary sequestration
Cryptogenic organizing pneumonia
Lung abscess
Rheumatoid pleuritis
Atypical pneumonia
Lobar pneumonia
Malignant pleural effusion
Pulmonary alveolar proteinosis