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Kao DD, Fuu-Kou Y, Wang CS, Lehenbauer D, Zak S, Benscoter D, Morales DL, de Alarcon A, Rutter MJ. Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies. Laryngoscope 2023; 133:3334-3340. [PMID: 37159210 DOI: 10.1002/lary.30737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty. METHODS This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes. RESULTS There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%). CONCLUSION This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3334-3340, 2023.
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Affiliation(s)
- Derek D Kao
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yann Fuu-Kou
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia S Wang
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Lehenbauer
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara Zak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Ls Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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An unusual cause of haemoptysis in childhood: A case report and literature review. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541508 PMCID: PMC8424777 DOI: 10.7196/sarj.2018.v24i3.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/08/2022] Open
Abstract
Haemoptysis is uncommon in children and the diagnosis is challenging. We describe a 14-year-old child who presented with haemoptysis secondary to a suspected congenital broncho-oesophageal fistula. This is a rare condition and the symptoms are insidious, occasionally beginning in childhood but may present only in adulthood. The case report describes the presentation, diagnosis and management of broncho-oesophageal fistulas, with a review of the current literature.
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Chen IC, Lin JY, Yang SN, Dai ZK. Congenital bronchoesophageal fistula repaired by bronchoscopy-assisted fistulectomy in a neonate. Kaohsiung J Med Sci 2014; 30:53-4. [PMID: 24388060 DOI: 10.1016/j.kjms.2013.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/14/2012] [Indexed: 11/24/2022] Open
Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jao-Yu Lin
- Department of Pediatric Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - San-Nan Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Chung JH, Lim GY, Kim SY. Esophageal lung diagnosed following the primary repair of esophageal atresia with tracheo-esophageal fistula in a neonate. Surg Radiol Anat 2013; 36:397-400. [PMID: 23900505 DOI: 10.1007/s00276-013-1173-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/09/2013] [Indexed: 11/26/2022]
Abstract
Communicating bronchopulmonary foregut malformations are a diverse group of congenital anomalies characterized by a fistula between the respiratory and alimentary systems. Among these malformations, the association of an esophageal lung with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) is extremely rare. We report the case of a neonate with esophageal lung detected following the primary repair of EA with TEF. Despite the rarity of esophageal lung with EA and TEF, it should be considered to develop in infants with abnormal findings on chest radiographs and an unusual preoperative and/or in the postoperative clinical course of EA and TEF. Swallowing study with water-soluble contrast medium is the investigation of choice to demonstrate the anatomic connection, if EA and TEF were already primarily repaired. If not, although the use of preoperative CT may be debatable in neonates due to the associated radiation exposure, in selected cases such as our patient, preoperative CT can be useful for early preoperative diagnosis.
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Affiliation(s)
- Jae Hee Chung
- Department of Surgery, Yeouido St' Mary's Hospital, The Catholic University of Korea, 62 Youido-dong, Youngdeungpo-gu, Seoul, 150-713, Korea,
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Boersma D, Koot BG, van der Griendt EJ, van Rijn RR, van der Steeg AF. Congenital bronchopulmonary foregut malformation initially diagnosed as esophageal atresia type C: challenging diagnosis and treatment. J Pediatr Surg 2012; 47:e59-62. [PMID: 23084235 DOI: 10.1016/j.jpedsurg.2012.07.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022]
Abstract
Communicating bronchopulmonary foregut malformations are extremely rare congenital malformations, characterized by a communicating fistula between an isolated part of the respiratory system and the esophagus or the stomach. In this article, we present a case of esophageal atresia type C, later diagnosed as a rare form of a communicating bronchopulmonary foregut malformation, an esophageal atresia combined with right main bronchus originating from the lower esophagus. Therapeutic resection of the right lung was complicated by postpneumonectomy syndrome.
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Affiliation(s)
- Doeke Boersma
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands.
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Katz R, Pitt R, Kim D, Wingrove B. Thoracoscopic pneumonectomy for communicating bronchopulmonary foregut malformation in a 4-month-old child. J Pediatr Surg 2010; 45:427-9. [PMID: 20152368 DOI: 10.1016/j.jpedsurg.2009.11.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 10/19/2022]
Abstract
Thoracoscopic total pneumonectomy has recently been described in the pediatric literature for the first time (Anselmo D, Perez I, Shaul D. Thoracoscopic Pneumonectomy for Severe Bronchiectasis in a 9-Year-Old Female. J Laparoendosc Adv Surg Tech 2008;18:775-777). In this article, we describe the use of thoracoscopic pneumonectomy in a 4-month-old boy with a complete (entire left lung) communicating bronchopulmonary foregut malformation. The patient is a 4-month-old boy who presented with persistent cough and low-grade fever. Chest radiograph was performed and showed a diffuse infiltrative pattern in the left lung. Computed tomography was then performed and revealed a poorly aerated abnormal left lung with absence of the left main stem bronchus. Subsequently, the patient underwent an upper gastrointestinal (UGI) series, which demonstrated that the left main stem bronchus arose from the distal esophagus and had no communication with the trachea. The patient tolerated a left thoracoscopic pneumonectomy very well. On postoperative day 5, a UGI demonstrated a question of a small contained leak. Therefore, a repeat study was performed 1 week later and did not demonstrate a leak. He was discharged in good health. Communicating bronchopulmonary foregut malformations are rare anomalies that require resection of the anomalous lung segment. This can be safely performed with a thoracoscopic technique even if it requires a pneumonectomy.
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Affiliation(s)
- Ryan Katz
- Atlanta Medical Center, Atlanta, GA 30312, USA.
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Iwazawa T, Imazato M, Ohnishi T, Kimura Y, Yano H, Monden T. Double congenital bronchoesophageal fistulae in an adult. ACTA ACUST UNITED AC 2004; 52:386-9. [PMID: 15384715 DOI: 10.1007/s11748-004-0017-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.
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Affiliation(s)
- Takashi Iwazawa
- Department of Surgery, NTT West Osaka Hospital, Osaka, Japan
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Gil Martínez EM, Ponce Herrera C, Acevedo Báñez I, Ruiz Franco-Baux JV. [Utility of esophageal scintigraphy in congenital "H" type tracheoesofagea fistula]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2004; 23:279-81. [PMID: 15207213 DOI: 10.1016/s0212-6982(04)72299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We present the case of 15 day old female baby, with respiratory insufficiency, asphyxia and cyanosis when fed. She was diagnosed by ultrasound of intraauricular communication ostium secundum type. Passage of the contrast to the right respiratory tract but without localization of the fistula was observed in the esophagogastric contrast study. We performed esophageal scintigraphy that showed the passage of the isotope to both lungs, showing "H" type tracheoesophageal fistula. We review the bibliography on this special kind of disease.
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