Pneumology - Reviews Open access

Bronchocele, a common but underrecognized condition: a systematic review

Authors

Published
22 April 2022
Section
Pneumology - Reviews
DOI
10.4081/monaldi.2022.2133

Abstract

Bronchocele is an abnormal accumulation of mucus often with associated bronchial dilatation. It can be due to either increased production or impaired drainage of mucus in the airways. Diseases like chronic bronchitis, bronchial asthma, bronchiectasis are characterized by high mucus production and other atypical conditions are bronchorrhea and plastic bronchitis with different physical characteristics and compositions of mucus. Improper drainage can lead to bronchocele formation due to underlying benign, malignant tumours or bronchial stenosis. Allergic bronchopulmonary aspergillosis (ABPA) has a peculiar appearance with high attenuated mucus (HAM) in imaging. Careful evaluation of bronchocele is needed as it can be associated with bronchial obstruction or rare causes like plastic bronchitis. Proper identification, evaluation for the underlying cause is key for not missing the underlying diagnosis and accurate treatment.

Keywords

References

  1. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology 2008;246:697–722. DOI: https://doi.org/10.1148/radiol.2462070712
  2. Papavramidou NS, Christopoulou-Aletras H. Treatment of “hernia” in the writings of Celsus (First century AD). World J Surg 2005;29:1343–7. DOI: https://doi.org/10.1007/s00268-005-7808-y
  3. Laios K, Lagiou E, Konofaou V, et al. From thyroid cartilage to thyroid gland. Folia Morphol 2019;78:171–3.
  4. Ellis H. The early days of thyroidectomy. J Perioper Pract 2011;21:215–6. DOI: https://doi.org/10.1177/175045891102100606
  5. Ring J. Mr Ring, on bronchocele. Med Phys J 1801;5:38–40.
  6. Heher WP. Acute bronchocele. Indian Med Gaz 1881;16:81–2.
  7. Lemire P, Trepanier A, Hebert G. Bronchocele and blocked bronchiectasis. Am J Roentgenol 1970;110:687–93. DOI: https://doi.org/10.2214/ajr.110.4.687
  8. Fahy JV, Burton FD. Airway mucus function and dysfunction. N Engl J Med 2010;363:2233-47. DOI: https://doi.org/10.1056/NEJMra0910061
  9. Rogers DF. Physiology of airway mucus secretion and pathophysiology of hypersecretion. Respir Care 2007;52:1134-46; discussion 1146-9.
  10. Rubin BK. Secretion properties, clearance, and therapy in airway disease. Transl Respir Med 2014;2:6. DOI: https://doi.org/10.1186/2213-0802-2-6
  11. Wang Y, Dai W, Sun Y, et al. Congenital bronchial atresia: Diagnosis and treatment. Int J Med Sci 2012;9:207–12. DOI: https://doi.org/10.7150/ijms.3690
  12. Jederlinic PJ, Sicilian LS, Baigelman W, Gaensler EA. Congenital bronchial atresia. A report of 4 cases and a review of the literature. Medicine (Baltimore) 1987;66:73–83. DOI: https://doi.org/10.1097/00005792-198701000-00003
  13. Gipson MG, Cummings KW, Hurth KM. Bronchial atresia. RadioGraphics 2009;29:1531–5. DOI: https://doi.org/10.1148/rg.295085239
  14. Zirpoli S, Munari AM, Primolevo A, et al. Agreement between magnetic resonance imaging and computed tomography in the postnatal evaluation of congenital lung malformations: a pilot study. Eur Radiol 2019;29:4544–54. DOI: https://doi.org/10.1007/s00330-019-06042-w
  15. Paramalingam S, Parkinson E, Sellars M, et al. Congenital segmental emphysema: An evolving lesion. Eur J Pediatr Surg 2010;20:78–81. DOI: https://doi.org/10.1055/s-0029-1246129
  16. Partridge EA, Victoria T, Coleman BG, et al. Prenatal diagnosis of oesophagal bronchus — first report of a rare foregut malformation in utero. J Pediatr Surg 2015;50:306–10. DOI: https://doi.org/10.1016/j.jpedsurg.2014.11.025
  17. Primetis E, Koureas A, Dalakidis A, et al. Congenital bronchial atresia with a calcified mucocele. Respir Int Rev Thorac Dis 2011;81:511–2. DOI: https://doi.org/10.1159/000324270
  18. Taccone A, Romano L, Marzoli A, et al. High-resolution computed tomography in cystic fibrosis. Eur J Radiol 1992;15:125–9. DOI: https://doi.org/10.1016/0720-048X(92)90137-X
  19. Gaeta M, Vinci S, Minutoli F, et al. CT and MRI findings of mucin-containing tumors and pseudotumors of the thorax: pictorial review. Eur Radiol 2002;12:181–9. DOI: https://doi.org/10.1007/s003300100934
  20. Occelli A, Size S, Ranch C, et al. Bronchocele density in cystic fibrosis as an indicator of allergic broncho-pulmonary aspergillosis: A preliminary study. Eur J Radiol 2017;93:195–9. DOI: https://doi.org/10.1016/j.ejrad.2017.05.047
  21. Koh W-J, Han J, Kim TS, Lee KS, Jang HW, Kwon OJ. Allergic bronchopulmonary aspergillosis coupled with broncholithiasis in a non-asthmatic patient. J Korean Med Sci 2007;22:365–8. DOI: https://doi.org/10.3346/jkms.2007.22.2.365
  22. Venarske DL, deShazo RD. Sinobronchial allergic mycosis: the SAM syndrome. Chest 2002;121:1670–6. DOI: https://doi.org/10.1378/chest.121.5.1670
  23. Zinreich SJ, Kennedy DW, Malat J, et al. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 1988;169:439–44. DOI: https://doi.org/10.1148/radiology.169.2.3174990
  24. Agarwal R, Aggarwal AN, Gupta D. High-attenuation mucus in allergic bronchopulmonary aspergillosis: another cause of the diffuse high-attenuation pulmonary abnormality. AJR Am J Roentgenol 2006;186:904. DOI: https://doi.org/10.2214/AJR.05.0125
  25. Singh H, Jetley RK, Maurya V, Saini M. Endobronchial tubercuclosis presenting as a bronchocele. Med J Armed Forces India 2001;57:68–9. DOI: https://doi.org/10.1016/S0377-1237(01)80099-X
  26. Jenson M, Forshee WA, Padilla RM, Wynn G. Endobronchial tuberculosis and bronchostenosis: A rare case of bronchial occlusion in a patient with history of tuberculosis. Cureus 2021;13:e12717. DOI: https://doi.org/10.7759/cureus.12717
  27. Khandelwal A, Damor A, Patil A, et al. A case of chronic bronchocele and blocked bronchiectasis mimicking bronchogenic carcinoma. Chest 2019;155:64A. DOI: https://doi.org/10.1016/j.chest.2019.02.076
  28. Saadé-Yordán C, McBurney-Henriquez E, González-Santoni R, et al. Marked 18-fuorine-fluorodeoxyglucose (FDG) avidity of an intrapulmonary typical carcinoid tumor manifesting as a bronchocele in an asymptomatic middle-aged woman. Am J Case Rep 2017;18:1390-5. DOI: https://doi.org/10.12659/AJCR.906678
  29. Aronberg D, Sagel S, Jost R, Levitt R. Oat cell carcinoma manifesting as a bronchocele. Am J Roentgenol 1979;132:23–5. DOI: https://doi.org/10.2214/ajr.132.1.23
  30. Farrell C, Goggins M, Casserly B. Unexpected diagnosis resulting from the presentation with chronic obstructive pulmonary disease (COPD) exacerbation. J Case Rep Images 2019. DOI: https://doi.org/10.36811/jcri.2019.110007
  31. Calais J, Lussato D, Menard J, et al. Resection of a solitary pulmonary metastasis from prostatic adenocarcinoma misdiagnosed as a bronchocele: Usefulness of 18F-choline and 18F-FDG PET/CT. J Thorac Oncol 2014;9:1826–9. DOI: https://doi.org/10.1097/JTO.0000000000000270
  32. Raza SA, Alexakis C, Creagh M, et al. Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report. J Med Case Reports 2009;3:1–4. DOI: https://doi.org/10.4076/1752-1947-3-8581
  33. Bhalla D, Naranja P, Bhalla AS, et al. Predicting histology of tracheobronchial neoplasms: A CT based differentiation model. Curr Probl Diagn Radiol 2022;51:189-95. DOI: https://doi.org/10.1067/j.cpradiol.2021.03.018
  34. Keal EE. Biochemistry and rheology of sputum in asthma. Postgrad Med J 1971;47:171–7. DOI: https://doi.org/10.1136/pgmj.47.545.171
  35. Shimura S, Sasaki T, Sasaki H, Takishima T. Chemical properties of bronchorrhea sputum in bronchial asthma. Chest 1988;94:1211–5. DOI: https://doi.org/10.1378/chest.94.6.1211
  36. Pahuja M, Shepherd RW, Lyckholm LJ. The use of octreotide to manage symptoms of bronchorrhea: a case report. J Pain Symptom Manage 2014;47:814–8. DOI: https://doi.org/10.1016/j.jpainsymman.2013.06.008
  37. Nakajima T, Terashima T, Nishida J, et al. Treatment of bronchorrhea by corticosteroids in a case of bronchioloalveolar carcinoma producing CA19-9. Intern Med 2002;41:225–8. DOI: https://doi.org/10.2169/internalmedicine.41.225
  38. Peter JV, Sudarsan T, Moran J. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med 2014;18:735–45. DOI: https://doi.org/10.4103/0972-5229.144017
  39. So SY, Lam WK, Sham MK. Bronchorrhea: A presenting feature of active endobronchial tuberculosis. Chest 1983;84:635–6. DOI: https://doi.org/10.1378/chest.84.5.635
  40. Smyrnios NA, Irwin RS, Curley FJ. Chronic cough with a history of excessive sputum production. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of a specific therapy. Chest 1995;108:991–7. DOI: https://doi.org/10.1378/chest.108.4.991
  41. Ntiamoah P, Mukhopadhyay S, Ghosh S, Mehta AC. Recycling plastic: diagnosis and management of plastic bronchitis among adults. Eur Respir Rev 2021;30:210096. DOI: https://doi.org/10.1183/16000617.0096-2021
  42. Schumacher KR, Singh TP, Kuebler J, et al. Risk factors and outcome of fontan‐associated plastic bronchitis: A case‐control study. J Am Heart Assoc 2014;3:e000865. DOI: https://doi.org/10.1161/JAHA.114.000865
  43. Grutter G, Di Carlo D, Gandolfo F, et al. Plastic bronchitis after extracardiac fontan operation. Ann Thorac Surg 2012;94:860–4. DOI: https://doi.org/10.1016/j.athoracsur.2012.04.043
  44. Patel N, Patel M, Inja R, et al. Plastic bronchitis in adult and pediatric patients: A review of its presentation, diagnosis, and treatment. Mo Med 2021;118:363–73.
  45. Aram A, Dalal B. The diagnosis and management of plastic bronchitis: a systematic literature review. Chest 2019;156:A1022. DOI: https://doi.org/10.1016/j.chest.2019.08.944
  46. Seear M, Hui H, Magee F, et al. Bronchial casts in children: a proposed classification based on nine cases and a review of the literature. Am J Respir Crit Care Med 1997;155:364–70. DOI: https://doi.org/10.1164/ajrccm.155.1.9001337
  47. Itkin M, McCormack FX, Dori Y. Diagnosis and treatment of lymphatic plastic bronchitis in adults using advanced lymphatic imaging and percutaneous embolization. Ann Am Thorac Soc 2016;13:1689-96. DOI: https://doi.org/10.1513/AnnalsATS.201604-292OC
  48. Weerakkody Y, Saber M. Mucoid impaction (lung). Radiopaedia [Internet]. Available from: https://radiopaedia.org/articles/31519
  49. Martinez S, Heyneman LE, McAdams HP, et al. Mucoid impactions: Finger-in-glove sign and other CT and radiographic features. RadioGraphics 2008;28:1369–82. DOI: https://doi.org/10.1148/rg.285075212
  50. Phuyal S, Garg MK, Agarwal R, et al. High-attenuation mucus impaction in patients with allergic bronchopulmonary aspergillosis: Objective criteria on high-resolution computed tomography and correlation with serologic parameters. Curr Probl Diagn Radiol 2016;45:168–73. DOI: https://doi.org/10.1067/j.cpradiol.2015.07.006
  51. Theriault M-M, Manos D. The double artery sign. J Thorac Imaging 2017;32:W3. DOI: https://doi.org/10.1097/RTI.0000000000000242
  52. Marchiori E, Hochhegger B, Zanetti G. Bronchial atresia with calcified bronchocele. J Bras Pneumol 2020;46:e20200263 DOI: https://doi.org/10.36416/1806-3756/e20200263
  53. .
  54. Saboo SS, Chamarthy M, Bhalla S, et al. Pulmonary arteriovenous malformations: diagnosis. Cardiovasc Diagn Ther 2018;8:325–37. DOI: https://doi.org/10.21037/cdt.2018.06.01
  55. Goo HW, Jhang WK, Kim YH, et al. CT findings of plastic bronchitis in children after a Fontan operation. Pediatr Radiol 2008;38:989–93. DOI: https://doi.org/10.1007/s00247-008-0937-3
  56. Jeung M-Y, Gasser B, Gangi A, et al. Bronchial carcinoid tumors of the thorax: Spectrum of radiologic findings. RadioGraphics 2002;22:351–65. DOI: https://doi.org/10.1148/radiographics.22.2.g02mr01351
  57. Xiong L, Rao X, Peng X, et al. Management of plastic bronchitis using α-chymotrypsin: A novel treatment modality. Cureus 2021;13:e13551. DOI: https://doi.org/10.7759/cureus.13551
  58. Colaneri M, Quarti A, Pozzi M, et al. Management of plastic bronchitis with nebulized tissue plasminogen activator: another brick in the wall. Ital J Pediatr 2014;40:18. DOI: https://doi.org/10.1186/1824-7288-40-18
  59. Tamaoki J, Chiyotani A, Kobayashi K, et al. Effect of Indomethacin on bronchorrhea in patients with chronic bronchitis, diffuse panbronchiolitis, or bronchiectasis. Am Rev Respir Dis 1992;145:548–52. DOI: https://doi.org/10.1164/ajrccm/145.3.548
  60. Homma S, Kawabata M, Kishi K, et al. Successful Treatment of refractory bronchorrhea by inhaled indomethacin in two patients with bronchioloalveolar carcinoma. Chest 1999;115:1465–8. DOI: https://doi.org/10.1378/chest.115.5.1465
  61. Hudson E, Lester JF, Attanoos RL, et al. Successful treatment of bronchorrhea with octreotide in a patient with adenocarcinoma of the lung. J Pain Symptom Manage 2006;32:200–2. DOI: https://doi.org/10.1016/j.jpainsymman.2006.05.003
  62. Lin S-C, Ho C-C, Yu C-J, Yang P-C. Dramatic improvement of severe bronchorrhea after gefitinib treatment in a patient with possible bronchioloalveolar carcinoma. Thorac Med 2006;21:82-7.
  63. Marom ZM, Goswami SK. Respiratory mucus hypersecretion (bronchorrhea): A case discussion—possible mechanism(s) and treatment. J Allergy Clin Immunol 1991;87:1050–5. DOI: https://doi.org/10.1016/0091-6749(91)92149-U
  64. Rémi C, Rémi J, Bausewein C. Pharmacological management of bronchorrhea in malignant disease: A systematic literature review. J Pain Symptom Manage 2016;51:916–25. DOI: https://doi.org/10.1016/j.jpainsymman.2015.12.335
  65. Leo F, Alexander L, Semper H, Grohé C. Use of anticholinergic and antifungal pharmacotherapy for the management of bronchorrhea in a patient with BRAF-mutated adenocarcinoma of the lung. J Pain Symptom Manage 2020;59:e14–6. DOI: https://doi.org/10.1016/j.jpainsymman.2019.10.001
  66. Krawetz SM, Mehta AC, Vijayakumar S, Stoller JK. Palliation of massive bronchorrhea. Chest 1988;94:1313–4. DOI: https://doi.org/10.1378/chest.94.6.1313-b

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2022 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.