A neonate with respiratory distress and unilateral pulmonary hyperinflation

Introduction: Bronchial atresia is characterized by a mucus-filled bronchocoele in a blind-ending segmental or lobar bronchus, with hyperinflation of the obstructed segment of lung.We report a case of bronchial atresia in a neonate with Congenital Cytomegalovirus infection. Case report: A 9-day old boy presented with history of increased work of breathing and cyanosis. Antenatal ultrasound at 22 weeks of gestation demonstrated hyper-echoic changes in the thorax and abdomen which did not progress throughout pregnancy. At presentation to hospital he was in moderate respiratory distress and was commenced initially on CPAP but he required mechanical ventilation in the 2nd week of life. He had a normal white cell count,C-reactive protein & negative blood cultures. CMV was detected by PCR in urine and blood, and in endotracheal aspirate samples. Blood samples from newborn screen taken on day 2 of life was also positive for CMV by PCR, CMV IgM antibody was also positive. A chest CT scan was performed (Figure A, B & C). The child had a right middle lobectomy & pathology revealed a bronchocoele with an 11mm mucus plug (Figure D) in a sub-segmental bronchus of the right middle lobe. CMV inclusions with minimal surrounding inflammation were noted on microscopy of the peripheral lung. In summary, this is the first reported case of bronchial atresia occurring with cCMV infection which may give further insight into the pathogenesis of this rare condition.