Mucocele of the lung due to congenital obstruction of a segmental bronchus; a case report; relationship to congenital cystic disease of the lung and to congenital bronchiectasis.

Miss M.S., Orange County General Hospital. This 15 year old Mexican female was admitted to the hospital March 21, 1949, with symptoms of weakness, easy fatigue, and feeling feverish. There was weight loss of 10 pounds over the previous two months and history of close contact with active tuberculosis in the preceding two years. Physical examination was not remarkable; there were slightly increased breath sounds at the right apex. X-ray films of the chest showed bilateral infiltrations of moderate degree and a circumscribed lesion in the left lung. She reacted to tuberculin. The sputum was negative, but a gastric culture was positive, establishing definitely the diagnosis of pulmonary tuberculosis. On a regimen of bed rest in the hospital, the pulmonary infiltrations decreased markedly, with the exception of the rounded density in the region of the apex of the lower lobe on the left side. X-ray films taken at several distinct intervals show this to persist (Figures 1 and 2 ) . It was featured by an air-fluid level. Because of this, the patient was seen in consultation, and it was considered that the rounded lesion should be removed surgically, the tentative diagnosis being either a congenital bronchial cyst with associated tuberculosis, or pulmonary tuberculosis with cavitation in the left lower lobe. On July 22, 1950 findings at operation were as follows: There were filmy adhesions between the superior and posterior segments and the adjacent chest wall. The arrangement of the lung was abnormal in the following respects : the basal segments were divided Into two equal portions by a long vertical fissure; there was a partial fissure between the superior segment of the lower lobe and the basal segments; the interlobar fissure was Incomplete, being totally absent in the posterior one-half; the bronchi of the posterior segment of the upper lobe originated from a subsegmental bronchus (B6b ‘ of the superior segment of the lower lobe, as illustrated, and thus traversed the posterior portion of the usual fissure line. Dissection revealed a smooth, rounded, pale, semitranslucent cyst-like dilatation of the bronchial system, extending through the superior and posterior segments. When an occasional branch was ruptured during the dissection, it was found to contain a large amount of thick, whitish, mucoid material (Figure 3). There was absolutely no evidence of inflammation or of solid deposit.