We report a case of localized bronchomalacia which was caused by endobronchial tuberculosis.
Bronchomalacia* ; Tuberculosis*

Gastroesophageal reflux disease (GERD) is closely related to respiratory issues. We reported the case about the nutrition intervention given to a male infant with congenital bronchomalacia, GERD, and recurrent pneumonia. During the first and second pediatric intensive care unit (PICU) stays, his nutrition status and nutrient intake were good. However, during the 18 days of the third PICU admission, his nutrient intake decreased to 75%–80% of his estimated calorie requirement and his Z-score for weight-for-age dropped to −1.4. We conducted nutritional interventions to improve GERD symptoms and nutritional status include avoiding overfeeding by feeding small amounts frequently, using a pre-thickened formula mixed with a high-calorie formula, and feeding through transpyloric tube. As a result, his daily nutrient intakes gradually increased and his Z-score for weight-for-age was normal. In conclusion, it is important to implement individualized intensive nutritional management to ensure adequate nutrition and growth status in infants with lung disease and GERD.
Bronchomalacia ; Enteral Nutrition ; Gastroesophageal Reflux ; Humans ; Infant ; Intensive Care Units ; Lung Diseases ; Male ; Nutritional Status ; Pneumonia

Pulmonary artery sling is a rare congenital cardiovascular anomaly which presents clinical obstructive symptoms and signs of trachea, right main bronchus and esophagus due to left pulmonary artery abnormaly arises from proximal part of right pulmonary artery. Aberrant left pulmonary artery courses to the right above right main bronchus and then turns to the left, and courses to between the anterior of the esophagus and the posterior aspect of trachea. One of important clinical significances of the pulmonary artery sling is associated with intracardiac anomalies, and with tracheal stenosis and bronchomalacia due to press tracheobronchial tree by the aberrant pulmonary artery. It has been thought that embryological malconnection between the pulmonary artery bud from left sixth arch and the pulmonary posterior branchial plexus in the left lung bud. We had experienced 21 months old male infant with left pulmonary artery sling associated with persistent left superior vena cava and dextropostioned heart. The heart seems to move to right hemithorax due to hypoplasia or segmental atelectasis of right lung.
Bronchi ; Bronchomalacia ; Esophagus ; Heart* ; Humans ; Infant ; Lung ; Male ; Pulmonary Artery* ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis ; Vena Cava, Superior*

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilatation and recurrent lower respiratory tract infections. It is thought to be due to a congenital anomaly. A diagnosis is typically made using computed tomography (CT) and bronchoscopy. Symptoms can range from minimal with preserved lung function to severe respiratory failure. Here, we present the case of a 50-year-old male who was referred to our hospital for chronic cough, sputum, and dyspnea. In addition, the patient showed tracheobronchomegaly with bronchomalacia on CT and bronchoscopy. This report describes a rare case of Mounier-Kuhn syndrome with a literature review.
Bronchomalacia ; Bronchoscopy ; Cough ; Dilatation ; Dyspnea ; Humans ; Lung ; Male ; Middle Aged ; Respiratory Insufficiency ; Respiratory Tract Infections ; Sputum ; Tracheobronchomegaly

PURPOSE: This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection. METHODS: The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 2007 to January 2013. RESULTS: A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases. CONCLUSION: Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered.
Anoxia ; Asthma ; Bronchiolitis ; Bronchomalacia ; Bronchoscopy ; Child ; Edema ; Hemorrhage ; Humans ; Hypotension ; Korea ; Male ; Medical Records ; Mucus ; Pediatrics ; Pneumonia ; Pulmonary Atelectasis ; Retrospective Studies ; Seizures, Febrile ; Tracheomalacia

PURPOSE: In adults, endoscopic tracheobronchial balloon dilatation and stenting have become valuable methods to establish and maintain an adequate airway lumen when tracheomalacia or neoplastic growth compromise the airways. But in children, only a few cases were reported due to technical problems. We report six children who were treated with stent implantation and describe the use and safety of airway stents. METHODS: Six patients with severe airway obstruction were treated. We investigated the underlying medical problems, stenotic site, symptomatic improvement and complications, and the size and location of stent. RESULTS: The median age of the six patients was 21 months. Three of them were mechanically ventilated and one had an endotracheal tube to maintain the patency of airway. Diagnoses were:congenital tracheal stenosis with or without bronchomalacia, granulation tissue formation after right upper lobectomy by bronchial carcinoid or after prolonged intubation, endobronchial tuberculosis, and airway compression by mediastinal undifferentiated sarcoma. Nitinol stents were implanted in the airway guided by bronchoscopy and fluoroscopy simultaneously. Three cases were placed in trachea, the others were in the bronchus. After stent implantation, all patients showed marked improvements of their airway obstructive symptoms. Four patients are doing well, although two expired due to underlying diseases. Four patients had granulation tissue formation around stents, but that was tolerable after removing the stent. CONCLUSION: We suggest that the use of expandible metallic stent implantation can offer safe therapeutic option even in extremely severe, life threatening and inoperable airway stenosis in children.
Adult ; Airway Obstruction ; Bronchi ; Bronchomalacia ; Bronchoscopy ; Carcinoid Tumor ; Child* ; Constriction, Pathologic* ; Diagnosis ; Dilatation ; Fluoroscopy ; Granulation Tissue ; Humans ; Intubation ; Only Child ; Sarcoma ; Stents* ; Trachea ; Tracheal Stenosis ; Tracheomalacia ; Tuberculosis

Pulmonary artery sling with bridging bronchus is not only rare but also difficult to diagnose unless specially sought. When young infant suffers from prolonged or recurrent wheezing, possibility of underlying anomalies of the tracheobronchial trees or great vessels should be considered, even though bronchiolitis and gastroesophageal reflux are the most common causes. We experienced four cases of pulmonary artery sling with bridging bronchus who presented with dyspnea and recurrent wheezing since infancy. Diagnosis was made using bronchoscopy, three dimensional computed tomography, echocardiography and angiography. Bridging bronchus of three patients (case 1, 2, 3) correspond to type IIA and one patient (case 4) to type IIB by Wells classification. Bronchoscopic examinations on 3 patients showed segmental bronchomalacia and near complete obstruction of bronchus by the posterior left pulmonary artery. These congenital bronchial anormalies should be included in differential diagnosis in pediatric patients with unexplained persistent and recurrent wheezing, or emphysema of unknown etiology on plain chest X-ray.
Angiography ; Bronchi* ; Bronchiolitis ; Bronchomalacia ; Bronchoscopy ; Classification ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Echocardiography ; Emphysema ; Gastroesophageal Reflux ; Humans ; Infant ; Pulmonary Artery* ; Respiratory Sounds ; Thorax

Congenital lobar emphysema is a rare disease and a cause of respiratory distress in early infancy. The most common location of pulmonary involvement is the left upper lobe. We diagnosed a case of congenital lobar emphysema in a 5-month-old female infant, who had a complex heart disease using flexible bronchoscopy. In spite of palliative heart surgery, respiratory difficulty and cyanosis did not improve and weaning from artificial ventilation was not possible. Chest X-ray and CT scan showed persistent hyperinflation in the left upper lobe. So, we performed flexible bronchoscopy. The findings showed no cartilage and patent bronchus during inspiration, but complete collapse during expiration due to a check valve effect in the left upper lobar bronchus. After excision of the involved lobe, the patient improved from respiratory distress. The observed airway patency during inspiration, and dynamic airway collapse on expiration suggest that bronchomalacia contributed to lung overinflation in this case.
Bronchi ; Bronchomalacia ; Bronchoscopy ; Cartilage ; Cyanosis ; Emphysema* ; Female ; Heart Diseases ; Humans ; Infant ; Lung ; Rare Diseases ; Thoracic Surgery ; Thorax ; Tomography, X-Ray Computed ; Ventilation ; Weaning

PURPOSE: Pediatric bronchoscopy is becoming an essential tool for diagnosis and treatment of pediatric respiratory tract diseases. But there is no international standard for the indication, procedure and bronchoalveolar lavage. We experienced 110 cases over 1 year for pediatric bronchoscopy and reported datas for them. METHOD: We used Olympus 3C30 pediatric bronchoscope and Wolfs rigid bronchoscopes for the bronchoscopy. Atropine intravenous injections was given as an premedication before 30 minutes of the bronchoscopy procedure. Midazolam was used as a main sedative and fentanyl, and droperidol was used for reduction of pain during procedures. We recorded the findings using videotapes and discussed the findings later. BAL was done if it needed and made a cell count and cultured the BAL fluid for the identifying the causative organisms. RESULTS: 1) Among 110 cases, male were 78 (72%), female were 32 (28%). Age distributions were 42 (37%) in 3-6 year of age, 21 (19%) in 1-3 year of age and the median is 4 year of age. 2) Indications are followings; Chronic cough 42, acute severe pneumonia 26, chronic/recurrent infiltrate 10, pulmonary TB with abnormal radiograph 10, stridor 6, abnormal airway radiograph 6, abnormal voices 5, persistent wheezing 4, foreign body suspected 3, pulmonary toilet with debilitated patient 1, management of artificial airway 1. Primary bronchoscopic findings were as followings; normal findings 21, pus 40, laryngomalacia 19, tracheomalacia 9, mucosa abnormality 5, vocal cord abnormality 5, bronchomalacia, 3, edema 2, obstruction, 2, constriction 1, tracheal bronchus 1 case. 3) Complications of bronchoscopy were fever, hypoxia, laryngospasm and epistaxis. 4) Cell differential analysis of 49 cases, neutrophil predominance 33 (68%), lymphocyte predominance 6 (12%), macrophage predominance 8 (16%), eosinophil predominance 2 (4%). 5) Cultures for bacteriae were included as followings; Stenotrephomonas maltophilia 17, Streptococcus mitis 13, alpha-hemolytic-Streptococcus 6, Klebsiella pneumoniae 6 cases. But it seems to be contaminated. But some organisms, Moraxella species, H. influenza may be causative organisms of pulmonary infections. 6) Ten AFB smear positive cases were discovered. Among them only one case was TB-PCR positive and the other nine cases were TB-PCR negative and two cases were PCR positive for mycobacterium other than tuberculosis (MOTT). It suggests that MOTT infections may be a role for pediatric chronic cough. CONCLUSION: Pediatric bronchoscopy made us far advanced improvement in diagnosis and management of pediatric pulmonary diseases.
Age Distribution ; Anoxia ; Atropine ; Bacteria ; Bronchi ; Bronchoalveolar Lavage ; Bronchomalacia ; Bronchoscopes ; Bronchoscopy* ; Cell Count ; Constriction ; Cough ; Diagnosis ; Droperidol ; Edema ; Eosinophils ; Epistaxis ; Female ; Fentanyl ; Fever ; Foreign Bodies ; Humans ; Influenza, Human ; Injections, Intravenous ; Klebsiella pneumoniae ; Laryngismus ; Laryngomalacia ; Lung Diseases* ; Lymphocytes ; Macrophages ; Male ; Midazolam ; Moraxella ; Mucous Membrane ; Mycobacterium ; Neutrophils ; Pneumonia ; Polymerase Chain Reaction ; Premedication ; Respiratory Sounds ; Respiratory Tract Diseases ; Streptococcus mitis ; Suppuration ; Tracheomalacia ; Tuberculosis ; Videotape Recording ; Vocal Cords ; Voice ; Wolves