Purpose or Case Report: The bridging bronchus is a rare bronchus anomaly which mostly found in infants and children. Aberrant bronchus that arises from either right or left main bronchus and crosses the mediastinum to supply the collateral lung lobe has come to the term of bridging bronchus. The diagnosis is often challenging as the bridging bronchus itself can be asymptomatic or presented by recurrent respiratory distress, but the use of right protocol in cross-sectional imaging is helpful enough to find the bridging bronchus.
This case report aims to present a case of a 5-month-old boy with recurrent pneumonia. He experienced episodes of severe dyspnea, fever, and desaturation, with negative PCR for covid-19. His echocardiography showed a moderate ventricular septal defect (VSD), worsening his dyspnea episodes which were accompanied by the decrease of oxygen saturation to 92% in room air. He underwent VSD closure procedure, which omitted the desaturation episodes, yet still experienced recurrent episodes of dyspnea and fever within 4 months of follow-up. In each episode, he had to be hospitalized and received conventional therapy by using antibiotics, bronchodilators, corticosteroids. Computed tomography (CT) scan of thorax using the pediatric radiation dose was done to evaluate the cause of recurrent pneumonia. Imaging findings in post-contrast slices (taken in inspiration phase) showed no connection between right lower lobe and left main bronchus, which was then suspected as esophageal bronchus. Then, in pre-contrast slices (taken in expiration phase) showed branch of the trachea into a right main bronchus and a stenotic aberrant bronchus (bridging bronchus, type 2) to the left hemithorax, and branching as right lower lobe bronchus and left main bronchus. Further evaluation of all slices in CT scan of thorax showed the stenotic bridging bronchus occluded in post-contrast slices, which were accidentally taken in inspiration phase. The occluded bridging bronchus led to non-optimal ventilation of the left lung lobes and right lower lobe, causing an imbalance of mucus clearance. Thus, increases the risk of mucus accumulation and rise the bacterial risk of infection which manifests as recurrent pneumonia in this patient. Nevertheless, within four months of follow up the patient was discharged with stable condition and symptoms-free.
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Conclusions: A thorough evaluation of the cross-sectional imaging of thorax is needed in finding a bridging bronchus that mimics esophageal bronchus.