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A 13-month-old infant was referred for evaluation of a severe, therapy-resistant asthma. He presented with daily wheezing, recurrent acute exacerbations, chronic dry-to-wet cough and failure to thrive. His mother had severe allergic asthma with recent admission to the intensive care unit. Initial chest X-rays were normal and skin prick tests were negative. It was decided to undertake a comprehensive work-up to exclude differential diagnoses. Paediatric radiologists initially interpreted the chest CT scan as normal. Bronchoscopic examination revealed an accessory cardiac bronchus (ACB) originating from the medial wall of the intermediate bronchus and filled with purulent secretions (108 Haemophilus influenzae and 108 Moraxella catarrhalis on bronchoalveolar lavage). The lesion was observed on re-examination of the CT scan (figure 1A, B) and demonstrated using three-dimensional (3D) virtual bronchoscopy and surface-rendered reconstructions (figure …
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