O2181: A Multicenter Evaluation of Current Management Patterns of Segmental Bronchial Atresia

Saturday, September 27, 2025

10:50 AM - 10:55 AM MDT

Location: Colorado Convention Center, Mile High Ballroom 2B-3B

Background: The management of segmental bronchial atresia (BA) is controversial. Proponents of surgical management cite risks of complications similar to other types of congenital lung malformations (CLM) such as infection or malignant degeneration. Those who practice non-operative management consider isolated BA a benign lesion that can be monitored when asymptomatic and stable on imaging. We aim to evaluate the current practice patterns in the management of segmental BA within the CLM Study Group, a national consortium of major children’s hospitals.

Methods: After Institutional Review Board (IRB) approval at the data coordinating center (IRB-00412128) and local IRB (IRB-AAAU8215), a multi-institutional retrospective cohort study of children with a CLM managed at 17 children’s hospitals between 2016 and 2024 was performed. The management strategies and outcomes of those with a diagnosis of BA on postnatal CT imaging were evaluated. Descriptive statistics were used for data analysis.

Results: Of 1536 patients with CLMs, 142 (9.2%) were suspected to have BA on postnatal CT imaging. Sixty-two (43.7%) of those also had suspicion of other CLM on radiographic diagnosis and were excluded from subsequent analysis. Of the remaining 80 patients with isolated BA, 45 (56.3%) underwent non-operative management and 35 (43.8%) underwent operative resection at a median age of 6 months (IQR 4.5, 10.5). There was significant variability in management practices within and among institutions (Figure 1). The most common indication for resection was prevention of infection and/or malignancy in asymptomatic patients (30; 85.7%). Four patients (11.4%) were symptomatic with hospital admissions for bronchiolitis, cough, wheezing, respiratory distress, and hypoxia prior to resection. These patients underwent resection at a later median age of 17 months [IQR, 14.2, 42.8]. BA commonly involved the left lower lobe (n=12; 34.3%), left upper lobe (n=11; 31.4%), or right lower lobe (n=9; 25.7%) and the majority were resected via lobectomy (n=30; 85.7%). Infants undergoing non-operative management were followed for a median of 23.5 months [IQR 13.7, 44.4] by pediatric surgeons (34; 75.6%) and/or pulmonologists (12; 26.7%). During surveillance, five patients developed pneumonia (11.1%) at a median age of 11 months [IQR 10, 21], with one requiring hospital admission. Six patients (13.3%) required hospital admission for respiratory-related symptoms, such as cough, bronchiolitis, viral URI, viral syndrome, fever and COVID, and RSV infection. Post-operatively, three patients (8.6%) still developed pneumonia, one of which required hospital admission. Two additional patients (5.7%) also required hospital admission for shortness of breath and respiratory distress as well as an adenovirus infection.

Conclusion: Segmental BA is a rare type of CLM with variable presentation and diverse management. Further analysis of its specific imaging characteristics is needed to better characterize this type of CLM and to further elucidate the role of nonoperative versus operative management for these patients.

Presenting Author(s)

Yeu Sanz Wu, MD

PGY4 General Surgery Resident
University of Rochester Medical Center
University of Rochester Medical Center
Rochester, New York

Co-Author(s)

AM

Alysala Malik, BA

Medical Student
Columbia University Vagelos College of Physicians and Surgeons
Anne M. Sescleifer, MD

Postdoctorate Research Fellow
Johns Hopkins University
MR

Marissa Ray, MD, MS

post-doctoral research fellow
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio
Terry Buchmiller, MD

Attending Surgeon
Boston Children's Hospital
Boston Children's Hospital/ Harvard Medical School
CC

Casey M. Calkins, MD

Professor at the Medical College of Wisconsin - Pediatric surgeon
Children’s Wisconsin
The Medical College of Wisconsin, Wisconsin
Benjamin Carr, MD (he/him/his)

Assistant Professor of Surgery
Oregon Health & Science University
Portland, Oregon
DC

Darrell Cass, MD

Director of Fetal Surgery
Cleveland Clinic
JC

Joseph Church, MD

Pediatric surgeon
University of Michigan, CS Mott Children's Hospital
Sarkis Christopher Derderian, MD

Assistant Professor of Surgery, The Sandy Wolf Chair in Maternal Fetal Surgery
Children's Hospital Colorado
SF

Stephen J. Fenton, MD

Associate Professor of Pediatric Surgery
University of Utah School of Medicine, Utah
Anthony Ferrantella, MD

Pediatric Surgeon
Children's Healthcare of Atlanta
Emory University
BG

Brian Gray, MD

Pediatric surgeon
Indiana University School of Medicine, Riley Hospital for Children
PG

Patricia Greco, MD

Clinical Assistant Professor
University of Michigan
AK

Aimee Kim, MD

Attending Physician
Children's Hospital Los Angeles
Shaun M. Kunisaki, MD, MSc

Professor of Surgery
Johns Hopkins University, Maryland
IL

Inna Lobeck, MD, FACS, FAAP

Surgical Director, Fetal Health Center. Assistant Professor of Surgery
Children's Mercy Hospital - Kansas City
Peter T. Yu, MD MPH

Pediatric Surgeon
Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Orange County, Orange, CA; Department of Surgery, University of California Irvine Medical Center, Orange, CA
University of California - Irvine
Orange, California
Irving J. Zamora, MD, MPH

Director, Advanced Minimally Invasive Surgery, Associate Program Director, Pediatric Surgery Fellowship
Vanderbilt University Medical Center
Vanderbilt University School of Medicine
Nashville, Tennessee

Senior Author(s)

VD

Vincent Duron, MD

Associate Professor of Surgery (Pediatrics)
Columbia University Irving Medical Center