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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Right main bronchus perforation detected by 3D-image
  1. László Bense1,
  2. Gunnar Eklund2,
  3. Hakan Jorulf3,
  4. Árpád Farkas4,
  5. Imre Balásházy4,
  6. Göran Hedenstierna3,
  7. Ádám Krebsz4,
  8. Balázs Gergely Madas4,
  9. Jerker Eden Strindberg4
  1. 1Independent Researcher, Norsborg, Sweden
  2. 2Independent Researcher, Uppsala, Sweden
  3. 3Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
  4. 4Health and Environmental Physics Department, Hungarian Academy of Sciences KFKI Atomic Energy Research Institute, Budapest, Hungary
  1. Correspondence to Dr László Bense, laszlo.bense{at}


A male metal worker, who has never smoked, contracted debilitating dyspnoea in 2003 which then deteriorated until 2007. Spirometry and chest x-rays provided no diagnosis. A 3D-image of the airways was reconstructed from a high-resolution CT (HRCT) in 2007, showing peribronchial air on the right side, mostly along the presegmental airways. After digital subtraction of the image of the peribronchial air, a hole on the cranial side of the right main bronchus was detected. The perforation could be identified at the re-examination of HRCTs in 2007 and 2009, but not in 2010 when it had possibly healed. The occupational exposure of the patient to evaporating chemicals might have contributed to the perforation and hampered its healing. A 3D HRCT reconstruction should be considered to detect bronchial anomalies, including wall-perforation, when unexplained dyspnoea or other chest symptoms call for extended investigation.

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  • Competing interests The employer of ÁF, IB, ÁK and BGM received governmental funding for the submitted work.

  • Patient consent Obtained.

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