OBJECTIVES: To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis. METHODS: The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB. RESULTS: A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%. CONCLUSIONS The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.
Infant ; Child ; Humans ; Bronchoscopy/methods* ; Constriction, Pathologic/complications* ; Bronchial Diseases/therapy* ; Retrospective Studies ; Tuberculosis/diagnosis* ; Airway Obstruction/therapy*

BACKGROUND: Exposure to prenatal stress is associated with offspring allergic-disease development, and oxidative stress may mediate this relationship. OBJECTIVE: We aimed to evaluate whether leukocyte telomere length (LTL) shortening, a marker for exposure to oxidative stress, in early life is associated with increased risk of asthma development during the preschool period. METHODS: We assessed the follow-up clinical data of a subgroup from a birth cohort whose LTLs had been measured from cord-blood and 1-year peripheral-blood samples. We examined whether the LTLs would be associated with asthma development at the age of 2–4 years. RESULTS: The data of 84 subjects were analyzed. LTLs were measured from the cord-blood and 1-year peripheral blood of 75 and 79 subjects, respectively. Among them, 14 subjects (16.7%) developed bronchial asthma between 2–4 years old. Prenatally stressed subjects had marginally increased odds of developing asthma (p = 0.097). There was no significant difference in the odds of preschool-asthma development between the groups with shorter and longer cord-blood LTLs (odds ratio [OR], 0.651; 95% confidence interval [CI], 0.184–2.306) or in the odds between the groups with shorter and longer 1-year peripheral-blood LTLs (OR, 0.448; 95% CI, 0.135–1.483). Finally, subjects with both higher prenatal stress and shorter LTLs did not have significantly higher odds of preschool-asthma development (for cord-blood: OR, 1.242; 95% CI, 0.353–4.368; for 1-year peripheral-blood: OR, 1.451; 95% CI, 0.428–4.919). CONCLUSION: There was no significant association between early life LTLs and higher risk of bronchial-asthma development during the preschool years.
Asthma ; Bronchial Diseases ; Child, Preschool ; Cohort Studies ; Follow-Up Studies ; Humans ; Hypersensitivity ; Leukocytes ; Oxidative Stress ; Parturition ; Telomere

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
Accidents, Traffic ; Adolescent ; Bronchi* ; Bronchial Diseases ; Chest Pain ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Pneumoperitoneum* ; Rupture* ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

Adult ; Bronchi ; diagnostic imaging ; pathology ; Bronchial Diseases ; etiology ; pathology ; Female ; Hemoptysis ; etiology ; pathology ; Humans ; Young Adult

BACKGROUND: Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method. METHODS: During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points. RESULTS: The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients' bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months. CONCLUSIONS Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation.
Aged ; Bronchi ; surgery ; Bronchial Fistula ; etiology ; surgery ; Female ; Humans ; Lung ; surgery ; Lung Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Omentum ; transplantation ; Pleura ; surgery ; Pleural Diseases ; etiology ; surgery ; Pneumonectomy ; adverse effects ; Postoperative Complications ; etiology ; surgery ; Retrospective Studies ; Thoracotomy

This article reports 4 girls with clinical manifestations of recurrent cough and anemia. The age of onset was less than 4 years, and three of them had shortness of breath. None of them had acute hemoptysis. All the girls had positive results of hemosiderin test for bronchoalveolar lavage fluid. As for imaging examination, 3 patients had ground-glass opacity, and 1 had interstitial change. Three girls were given the treatment for idiopathic pulmonary hemosiderosis and had no response. Selective bronchial arteriography was performed for the 4 girls and found bronchial artery to pulmonary circulation shunt (BPS). After they were diagnosed with BPS, they were given transcatheter embolization. The girls were followed up for half a year after surgery, and none of them was readmitted due to "cough and anemia". BPS manifests as abnormal shunt between the bronchial artery and the pulmonary artery/vein and has unknown causes. It is rare in children and should be considered for children who were thought to have idiopathic pulmonary hemosiderosis and had poor response to corticosteroid therapy.
Anemia ; etiology ; Bronchial Arteries ; Child ; Child, Preschool ; Embolization, Therapeutic ; Female ; Hemorrhage ; complications ; Hemosiderosis ; complications ; Humans ; Lung Diseases ; complications ; Pulmonary Alveoli ; Pulmonary Circulation

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disease due to bronchial colonization of Aspergillus fumigatus that occurs in susceptible patients with asthma or cystic fibrosis. A 10-year-old girl was referred to the Department of Pediatric Pulmonology for persistent consolidations on chest radiography. Pulmonary consolidations were observed in the right upper and left lower lobes and were not resolved with a 4-week prescription of broad-spectrum antibiotics. The patient had a history of atopic dermatitis and allergic rhinitis but no history of asthma. She had no fever but produced thick and greenish sputum. Her breathing sounds were clear. On laboratory testing, her total blood eosinophil count was 1,412/mm3 and total serum IgE level was 2,200 kU/L. Aspergillus was isolated in the sputum culture. The A. fumigatus-specific IgE level was 15.4 kU/L, and the Aspergillus antibody test was also positive. A chest computed tomography scan demonstrated bronchial wall thickening and consolidation without bronchiectasis. An antifungal agent was added but resulted in no improvement of pulmonary consolidations after 3 weeks. Pulmonary function test was normal. Methacholine provocation test was performed, revealing bronchial hyperreactivity (PC20=5.31 mg/mL). Although the patient had no history of asthma or bronchiectasis, ABPA-seropositivity was suspected. Oral prednisolone (1 mg/kg/day) combined with antifungal therapy was started. Pulmonary consolidations began decreasing after 1 week of treatment and completely resolved after 1 month. This is the first observed and treated case of seropositive ABPA in Korean children without previously documented asthma.
Anti-Bacterial Agents ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Aspergillus fumigatus ; Asthma* ; Bronchial Hyperreactivity ; Bronchiectasis ; Child* ; Colon ; Cystic Fibrosis ; Dermatitis, Atopic ; Eosinophils ; Female ; Fever ; Humans ; Hypersensitivity ; Immunoglobulin E ; Lung Diseases ; Methacholine Chloride ; Prednisolone ; Prescriptions ; Pulmonary Medicine ; Radiography ; Respiratory Function Tests ; Respiratory Sounds ; Rhinitis ; Sputum ; Thorax

PURPOSE: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx. MATERIALS AND METHODS: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed. RESULTS: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty. CONCLUSION: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.
Adolescent ; Adult ; Aged ; Analysis of Variance ; Anastomosis, Surgical/*adverse effects/methods ; Bronchi/blood supply/physiopathology/*surgery ; Bronchial Diseases/epidemiology/*etiology/physiopathology ; Bronchoscopy ; Female ; Humans ; Incidence ; *Lung Transplantation ; Male ; Middle Aged ; Postoperative Complications/epidemiology/*etiology/physiopathology ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Treatment Outcome

Systemic arterial supply from the descending thoracic aorta to the basal segment of the left lower lobe without a pulmonary arterial supply is a rare congenital anomaly within the spectrum of sequestration lung disease. The most common pattern of anomalous systemic artery to the lung arises from the descending thoracic aorta and feeds the basal segments of the left lower lobe. We report an extremely rare case of a 29-year-old woman who underwent a successful left upper lobectomy for the treatment of recurrent massive hemoptysis from anomalous bronchial arterial supply to the lingular segment of left upper lobe.
Adult ; Aorta, Thoracic ; Arteries ; Bronchial Arteries* ; Bronchopulmonary Sequestration ; Female ; Hemoptysis* ; Humans ; Lung ; Lung Diseases

OBJECTIVE: The aim of this study was to evaluate whether the difference in the degree of collateral ventilation between canine and swine models of bronchial obstruction could be detected by using xenon-enhanced dynamic dual-energy CT. MATERIALS AND METHODS: Eight mongrel dogs and six pigs underwent dynamic dual-energy scanning of 64-slice dual-source CT at 12-second interval for 2-minute wash-in period (60% xenon) and at 24-second interval for 3-minute wash-out period with segmental bronchus occluded. Ventilation parameters of magnitude (A value), maximal slope, velocity (K value), and time-to-peak (TTP) enhancement were calculated from dynamic xenon maps using exponential function of Kety model. RESULTS: A larger difference in A value between parenchyma was observed in pigs than in dogs (absolute difference, -33.0 +/- 5.0 Hounsfield units [HU] vs. -2.8 +/- 7.1 HU, p = 0.001; normalized percentage difference, -79.8 +/- 1.8% vs. -5.4 +/- 16.4%, p = 0.0007). Mean maximal slopes in both periods in the occluded parenchyma only decreased in pigs (all p < 0.05). K values of both periods were not different (p = 0.892) in dogs. However, a significant (p = 0.027) difference was found in pigs in the wash-in period. TTP was delayed in the occluded parenchyma in pigs (p = 0.013) but not in dogs (p = 0.892). CONCLUSION: Xenon-ventilation CT allows the quantification of collateral ventilation and detection of differences between canine and swine models of bronchial obstruction.
Airway Obstruction/*radiography ; Animals ; Bronchial Diseases/*radiography ; Bronchography/*methods ; Disease Models, Animal ; Dogs ; Pulmonary Ventilation/*physiology ; Respiration ; Swine ; Tomography, Spiral Computed/*methods ; Xenon