Inflammatory endobronchial polyps in childhood: Clinical spectrum and possible link to mechanical ventilation

Abstract

Inflammatory polyps of the airways are now regarded as histopathologically distinct nonneoplastic endobronchial lesions, which in adults are associated with a variety of chronic inflammatory insults. However, their clinical presentation in the pediatric population is extremely rare, with the etiology of such polyps poorly defined. The clinical and histopathological data from four pediatric patients, identified in the histopathology files of the Royal Brompton Hospital, were retrospectively reviewed. Three out of 4 patients had a history of mechanical ventilation in the neonatal period. In these 3 patients, the polyps were all situated in the proximal airways on the right side. These 3 patients presented at 6 weeks, 7 weeks, and 2 years, respectively, and were successfully treated by polypectomy at rigid bronchoscopy, with subsequent return to normality. One patient, presenting at 12 years of age without history of iatrogenic intervention, underwent a left lower lobectomy for a polyp sited in a segmental bronchus. Presentation in 3 of the 4 patients was with lobar collapse. The fourth patient presented with hyperinflation. We conclude that inflammatory endobronchial polyps may be associated with a history of mechanical ventilation in the neonatal period, polyp formation perhaps being secondary to airway trauma. The small caliber of the main airways in neonates may also be a contributory factor in presentation.

Ball valve obstruction of a bronchus causing lobar emphysema in a neonate

“…Endobronchial tumours and polyps are an extremely rare cause of ALE [6]. The pedunculated endobronchial inflammatory polyp seen in this case demonstrates the ball valve mechanism of air trapping in lobar emphysema.…”

Endobronchial Mimics of Primary Endobronchial Carcinoma: A Clinical Study of 25 Cases

“…An inflammatory polyp related to repeated episodes of aspiration defined another cause of endobronchial obstruction. A variety of chronic inflammatory insults could lead to the development of this distinctive non-neoplastic endobronchial lesion (13).…”

Intrinsic Endobronchial Obstructions in Children from Turkey: Evaluation of 2,555 Flexible Bronchoscopic Procedures

“…Bronchial polyps are rarely seen in childhood and may occur secondary to long-term intubation or may be inflammatory [8,22]. One of our patients had a history of prolonged intubation, and in 3 patients polyps were inflammatory in nature and had disappeared by the time of follow-up.…”

“…Foreign bodies and impacted mucus are among the most commonly reported [1,2,3,4], followed by tuberculosis (TB)-related lesions and neoplasms [5,6,7]. Other less commonly reported causes are polyps, endometriosis, atypical mycobacterial infections and hydatid cyst membranes [8,9,10,11]. …”

“…Case reports or case series concerning only one of the causes of endobronchial obstructions in childhood are reported [2,6,7,8,11]. Some studies have revealed the presence of endobronchial diseases in certain conditions such as persistent atelectasis [3]; however, only a few studies have reported a spectrum of endobronchial obstructions in a wider group of children who underwent an FB procedure [4,14].…”