Clinical characteristics of children with tracheobronchial anomalies

Abstract

Tracheobronchial anomalies (TBA) originate between the third and sixteenth week of gestation, and they primarily affect the main bronchi. The reported incidence varies between 1-3% of pediatric endoscopic studies. The objective of our review was to describe the clinical characteristics of patients with TBA diagnosed by flexible bronchoscopy (FB). During the period from March 1993-May 2001, we performed 580 FB at the Pediatric Services of the Catholic University Hospital. During this study period, 52 patients (9.65%) had a TBA (32 males, or 61.5%), with a mean age of 21.2 months (range, 7 days to 6 years). In 39 cases (75%), the diagnosis was made under age 2 years. Thirty-six patients with symptoms related to TBA were symptomatic (70%), and in 16 cases (30%) the TBA was an accidental finding during FB. The main clinical manifestations were recurrent atelectasis of the right upper lobe (RUL), recurrent pneumonia, or congenital stridor. Most of the TBA were localized at the RUL bronchus (47%) and were characterized by an anomaly at its origin, either agenesis or a supernumerary bronchus. Also, we found patients with tracheal bronchus and congenital tracheal stenosis. In 6 patients (12%), we had more than one TBA, the most frequent being the association between RUL and RML anomalies. In 12 cases we found another congenital airway anomaly, mainly laryngomalacia. Patients had associated diseases, such as genetic disorders in 16 cases (particularly Down syndrome), and congenital cardiopathies. In summary, in our clinical experience, TBA are more frequent than previously reported. The majority of young patients have symptoms or signs, and most are localized to the RUL. We found patients with more than one TBA, laryngomalacia associated with TBA, and at a high frequency related to Down syndrome.

Tracheomalacia and Bronchomalacia in 34 Children: Clinical and Radiologic Profiles and Associations with Other Diseases

“…1,2,5,7,9 In our study, the occurrence of TBM, pharyngeal dyskinesia, and laryngomalacia (LM) together might be explained by a common embryonic developmental anomaly of the airways. When TM occurs in association with OA/TEF, pressure from the dilated and obstructed proximal esophageal pouch compresses the posterior wall of the trachea, preventing normal cartilage development.…”

Presence of tracheal bronchus in children undergoing flexible bronchoscopy

“…In our series, TB was diagnosed accidentally from patients which had flexible bronchoscopy for respiratory symptoms indications such as recurrent bronchopulmonary infections, persistent wheezing and difficult to treat asthma [14]. These two studies, in a general pediatric population and the other in children with respiratory symptoms, strongly suggest that TB has no or little clinical incidence even if recent case reports reveal associations with persistent atelectasis, hemoptysis, bronchiectasis requiring surgery of the involved segment and cases of lung cancer [5,8,9,15]. Our series highlights the frequency of TB in children with other congenital abnormalities such as tracheobronchial malformations, congenital heart disease or syndromic association.…”

Experiencia en 10 años de aplicación de fibrobroncoscopia en pacientes pediátricos

“…El resultado del estudio fue anormal en 67% de los casos, contribuyendo en la mayoría de los casos al manejo del paciente. Lo anterior se compara en forma cercana con nuestros hallazgos, describién-dose en nuestra serie un mayor número de malformaciones traqueobronquiales, y un porcentaje mayor de cultivos positivos en el lavado broncoalveolar 17,29 .…”