Purpose or Case Report: Esophageal bronchi are a rare form of communicating bronchopulmonary foregut malformations (CBPFM) that can be seen in association with esophageal atresia.

Esophageal bronchi are rare but important causes of an opaque hemithorax on chest radiograph. This is especially pertinent in the setting of esophageal atresia (EA) and tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) anomalies as these conditions are associated with a higher incidence of esophageal bronchi.

The purpose of this case report series is describe the pertinent radiological features in four patients with esophageal bronchi.

Methods & Materials: A literature review was performed to evaluate the various approaches to imaging the infant with a suspected bronchial anomaly.

The radiological features with emphasis on CT and UGI findings of esophageal bronchi in four neonatal patients are described.

Results:
Consolidation and atelectasis in conjunction with a low volume hemithorax and an abnormal carina or anomalous vascular anatomy suggest the possibility of an esophageal bronchus or an esophageal lung on CT.

Three of the four cases described occurred in the context of associated VACTERL anomalies. 2 of the 4 had EA and TEF.

None of the cases had a prenatal diagnosis but neither was the prenatal imaging normal. All demonstrated non-specific findings: two displayed polyhydramnios and two had intrauterine growth restriction.

CT Thorax is increasingly useful for establishing the diagnosis, confirmation of UGI findings and for assessment of parenchymal damage due to recurrent aspiration and infection.

Conclusions:
The radiologist has a key role in guiding the multidisciplinary approach to the diagnosis and treatment of children with suspected bronchial anomaly.

Consolidation and atelectasis in conjunction with a low volume hemithorax, ipsilateral mediastinal shift and an abnormal carina or anomalous vascular anatomy suggest the possibility of an esophageal bronchus or an esophageal lung on CT.

While esophageal bronchi are a rare cause of a white hemithorax, CT and UGI imaging play key roles in its diagnosis.

Familiarity with this diagnostic approach and prompt consideration of this diagnostic entity is of great clinical importance as early diagnosis, prior to the development of aspiration pneumonia, may allow consideration to parenchymal sparing surgery as opposed to pneumonectomy.