Chest / Cardiac for Thursday, June 4th, 2026

Contributed by Cincinnati Children's Hospital Medical Center
Liz England, and Paul Guillerman.

History

6-year-old with pectus excavatum and history of recurrent pneumonias with right upper lobe hyperinflation and right middle lobe and right lower lobe volume loss on imaging. Referring clinical service considering endoscopic lung volume reduction surgery or lobectomy.

Images (Click any image to enlarge)

CT Chest: Pre-procedural imaging
Xenon-129 MRI Chest #1: Pre-procedural imaging
129Xe MRI Chest #2: S/p Bronchoscopy and right upper lobe endobronchial valve placement. Patient underwent bronchoscopy after this MRI exam and the endobronchial valve found to be non-obstructing. The right upper lobe endobronchial valve was replaced.
Chest radiograph and 129Xe MRI chest #3 s/p right upper lobe endobronchial valve replacement.

Question

1. After technically successful endobronchial valve replacement, some gas still gets into the right upper lobe. What is the most likely explanation? 2. What anatomical pathways contribute to collateral ventilation?

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Check back 5 hours 23 minutes from now (after 7:00pm) for the answer and further discussion!