Recurrent respiratory tract infections in children; beyond medical causes!

Abstract

Submit Manuscript | http://medcraveonline.com required ventilator support. A paediatric surgery referral was sent in view of history of repeated admissions for severe recurrent RTI every 3-4 weeks since birth. A flexible endoscopic examination revealed a fistulous opening in the posterior wall of the trachea raising the suspicion of an H type trachea-oesophageal (TEF) fistula. On deeper probing, the mother gave a history of choking during feeds. After proper stabilization rigid bronchoscope under general anaesthesia revealed a fistula in the posterior wall of trachea which was first cannulated, and then ligated and repaired from the right cervical route ( Figure 1). The child was discharged after 10 days and was followedup for the next 10 months. He had no other episode of RTI which required admission. Figure 1 Rigid bronchoscopy showed an opening in the posterior wall of the trachea which was cannulated using ureteric catheter.Another 4 months old child admitted with history of recurrent RTI since birth with completely asymptomatic intervening periods. In the previous episode, the child was admitted with severe respiratory distress and was treated by left sided inter-costal tube drainage in view of left pneumothorax causing meditational shift (Figure 2 A). A CECT scan of the chest revealed hyper-lucent left sided lung field with mediastinal shift towards the right side ( Figure 2B). The left lower lobe remained collapsed with depressed left hemi-diaphragm. This child underwent left postero-lateral thoracotomy and left upper lobotomy ( Figure 3A). The child had congenital lobar emphysema of the left upper lobe ( Figure 3B). Figure 2A-Chest X-ray with hyper lucent left lung field extending across the mediastinal into the right side with retained broncho vascular markings suggestive of congenital lobar emphysema. 2B-CT scan suggestive of cystic lung lesion with collapse of the left lower lobe.Figure 3A-Left postero-lateral thoracotomy and left upper lobectomy done in a 4 month old boy for cystic lung lesion. 3B-Gross specimen and histology suggestive of congenital lobar emphysema of the left upper lobe.A 3-month-old girl presented with complaints of respiratory distress since 1.5 months and 1 episode of bloody expectoration 3 days back. On examination, she had tachycardia and tachypnea and chest auscultation revealed decreased air entry in the left upper zone. 1 The X-Ray chest was suggestive of a cavity lesion in the left upper lobe with surrounding area of consolidation. A Tc-99m pertechnetate scan showed avid uptake in this lesion suggestive of foregut duplication cyst. 1 This child underwent left posterolateral thoracotomy and excision of the thoracic part of a ruptured neuroenteric cyst. Many a time paediatricians encounter children who suffer from repeated life-J Pediatr Neonatal Care.