A rare bronchial anomaly presenting as a paracardiac mass

Abnormal bronchi arising from trachea and main bronchi are rare and usually clinically silent. These bronchial variations, however, pose a significant diagnostic challenge related to their variable presentation and perhaps the low level of awareness among clinicians and radiologists. Complications including recurrent infections, hemoptysis, and rarely malignancies may arise, if the diagnosis is delayed. We came across a patient with chronic cough in whom endoscopic and imaging evaluation, including fine-needle aspiration cytology (FNAC), proved non-diagnostic. Thorough evaluation of multidetector computed tomography (MDCT) performed in our department, however, revealed an accessory cardiac bronchus with rudimentary lung parenchyma in the paracardiac location. This case highlights the importance of meticulous airway evaluation on MDCT in all patients referred with respiratory symptoms.