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Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy. Paediatr Respir Rev 2023; 45:30-44. [PMID: 36635200 DOI: 10.1016/j.prrv.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Tubercular Bronchoesophageal Fistula in an Adolescent Girl. Indian J Pediatr 2022; 89:1107-1109. [PMID: 35226286 DOI: 10.1007/s12098-022-04116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
Abstract
Bronchoesophageal fistula is a rare complication of Mycobacterium tuberculosis in children. An adolescent girl who was diagnosed of tubercular mediastinal lymphadenopathy with associated bronchoesophageal fistula at presentation, is reported here. This 16-y-old girl presented with high-grade fever, cough, decreased appetite, weight loss for 3 mo, and breathlessness for 10 d. Chest radiograph revealed hilar lymphadenopathy with bilateral pleural effusion. GA GeneXpert was positive for mycobacterium and rifampicin sensitivity. Despite antitubercular therapy cough persisted and there was a history of dry cough with food intake, especially more on liquids. Bronchoscopy and CECT chest confirmed bronchoesophageal fistula in the right main bronchus just below the carina. Child continued on tube feeding and antitubercular therapy. After completion of intensive phase, child improved with resolution of clinical symptoms and scarring of tract on repeat bronchoscopy. It is concluded that in children with combination of mediastinal lymphadenopathy and persistent cough following intake of food needs careful evaluation for trachea/bronchoesophageal fistula.
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Goussard P, Retief F, Burke J, Malherbe A, Janson J. The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis. Ther Adv Infect Dis 2021; 8:20499361211037168. [PMID: 34422266 PMCID: PMC8377312 DOI: 10.1177/20499361211037168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopy is useful as a diagnostic and therapeutic procedure in children with Tuberculosis (TB) disease complicated by airway obstruction. It is needed in children when surgical intervention may be required for airway compression, when drug resistance is suspected, and to rule out an alternative diagnosis for airway obstruction. Bronchoscopy with bronchoalveolar lavage (BAL) should be performed when other, less invasive samples cannot be collected, or when they fail to provide useful diagnostic information. BAL specimens collected at bronchoscopy can be tested using molecular TB assays and mycobacterial culture. The aim of this review is to evaluate the role of bronchoscopy in the diagnosis and management of pulmonary TB in children, and, specifically, to review the role of interventional bronchoscopy. A search of electronic databases was undertaken using the online databases PubMed, Ovid MEDLINE, EMBASE, Google Advanced Scholar, and Web of Science to identify relevant literature. The search was limited to pediatrics, pulmonology, bronchoscopy, and pediatric pulmonary tuberculosis for all articles published in English on pediatric bronchoscopy between 2010 and 2020. Recent advances in pediatric bronchoscopy was included, as well as recent research on improving the diagnosis with the use of interventional bronchoscopy. The role of bronchoscopy in pediatric pulmonary tuberculosis has changed during the last decade, from a simple method of collecting samples for bacteriological conformation to an more sophisticate procedure. New methods are available for collecting samples, which includes the use of Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and also better methods of bacteriological conformation. Interventions are now possible; not only to improve the diagnostic abilities of bronchoscopy but also to diagnose, manage, and follow-up upon airway-related complications. Bronchoscopy services remain limited in resource-limited countries due to the high cost of equipment.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Francois Retief
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jonathan Burke
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Annemie Malherbe
- Department of Anaesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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Goussard P, Andronikou S, Morrison J, van Wyk L, Mfingwana L, Janson JT. Management of children with tuberculous broncho-esophageal fistulae. Pediatr Pulmonol 2020; 55:1681-1689. [PMID: 32275811 DOI: 10.1002/ppul.24775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Broncho-esophageal fistula (BOF) is a rare complication of Mycobacterium tuberculosis (MTB). TB-associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes. METHODS All children with TB- associated BOF were included. TB was diagnosed if MTB was cultured from respiratory secretions, Ziehl-Neelsen (ZN) smear was positive, GeneXpert MTB/RIF was positive or a chest radiograph revealed radiographic features typical of TB. BOF was diagnosed by a contrast swallow study and/or flexible bronchoscopy. Chest computed tomography (CT) scan was performed, if required. RESULTS Total of 20 children were diagnosed with TB-associated BOF between 1999 and 2019, with a 75% survival. A total of 85% BOF involved the left main bronchus. A total of 80% of patients were MTB culture or ZN smear-positive. Chest X-ray abnormalities included: extensive parenchymal disease (80%) and lymph gland enlargement (45%). CT features included visualization of the BOF (60%), esophageal air (73%) and pneumomediastinum (40%). BOF closure was achieved by surgical closure (46%), spontaneous closure (26%), fibrin glue (13%), and esophageal stent (13%). Multivariant regression analysis showed that C- reactive protein (CRP), albumin and CRP/albumin ratio were associated with mortality. CONCLUSION Most TB-associated BOF are left-sided. It presents either acutely, with respiratory failure, or with chronic respiratory symptoms of aspiration. Children requiring invasive ventilation have high mortality. Most TB-associated BOF requires surgical intervention, although the use of fibrin glue offers an attractive alternative option.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania
| | - Julie Morrison
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Lizelle van Wyk
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Lunga Mfingwana
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Jacques T Janson
- Department of Cardio-Thoracic Surgery, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
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Rana K, Bhargava EK, Batra V, Arora N, Meher R. Tuberculous Bronchoesophageal Fistula in Nephrotic Syndrome: A Silent Assassin. Indian J Otolaryngol Head Neck Surg 2019; 71:104-106. [PMID: 31741942 DOI: 10.1007/s12070-017-1130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/05/2017] [Indexed: 10/19/2022] Open
Abstract
Tuberculosis, a global public health concern, is emerging as an important complication in children with nephrotic syndrome. We report a case of an adolescent with nephrotic syndrome who developed fatal miliary tuberculosis after initiation of steroid therapy, presenting as a bronchoesophageal fistula. The case highlights the importance of maintaining a high index of suspicion prior to starting immunosuppressive therapy in pediatric patients of nephrotic syndrome.
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Affiliation(s)
- Kanika Rana
- Department of Otorhinolaryngology - Head and Neck Surgery, Maulana Azad Medical College and Associated Loknayak, G.N.E.C. and G.B. Pant Hospitals, New Delhi, India
| | - Eishaan Kamta Bhargava
- Department of Otorhinolaryngology - Head and Neck Surgery, Maulana Azad Medical College and Associated Loknayak, G.N.E.C. and G.B. Pant Hospitals, New Delhi, India
| | - Vasun Batra
- Department of Otorhinolaryngology - Head and Neck Surgery, Maulana Azad Medical College and Associated Loknayak, G.N.E.C. and G.B. Pant Hospitals, New Delhi, India
| | - Nikhil Arora
- Department of Otorhinolaryngology - Head and Neck Surgery, Maulana Azad Medical College and Associated Loknayak, G.N.E.C. and G.B. Pant Hospitals, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology - Head and Neck Surgery, Maulana Azad Medical College and Associated Loknayak, G.N.E.C. and G.B. Pant Hospitals, New Delhi, India
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Goussard P, Gie R. The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis. Expert Rev Respir Med 2013; 8:101-9. [DOI: 10.1586/17476348.2013.863712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nemati A, Safavi E, GhasemiEsfe M, Anaraki MZ, Firoozbakhsh S, Khalilzadeh O, Anvari M. Fistula formation between the right and left main bronchus caused by endobronchial tuberculosis. Am J Med Sci 2012; 343:330-1. [PMID: 22227512 DOI: 10.1097/maj.0b013e31823e612a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The prevalence of endobronchial tuberculosis (EBTB) in patients with active tuberculosis is about 10% to 40%. The most common complication of EBTB is bronchial stenosis. Fistula formation by pulmonary tuberculosis is a very rare complication and is most commonly bronchopleural. The authors present a 53-year-old woman presented with chronic cough and abnormality in chest computed tomography scan. According to chest computed tomography scan finding, bronchoscopic study was done and bronchial lavage was obtained. Bronchial lavage was positive for acid fast bacilli. Bronchoscopy showed fistula formation between the right and left main bronchus, a rare manifestation of EBTB. The patient was treated with antituberculosis therapy, and her symptoms improved and radiological findings showed regression of pulmonary lesions.
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Affiliation(s)
- Alireza Nemati
- Advanced Diagnostic and Interventional Thoracic Research Center, Imam Hospital, Tehran, Iran
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Erlank A, Goussard P, Andronikou S, Gie R, Sidler D, Ackermann C, Parsons J, Greyling J. Oesophageal perforation as a complication of primary pulmonary tuberculous lymphadenopathy in children. Pediatr Radiol 2007; 37:636-9. [PMID: 17525846 DOI: 10.1007/s00247-007-0482-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 03/11/2007] [Accepted: 03/25/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Involvement of the oesophagus by tuberculosis is rare, and erosion and perforation of the oesophagus by tuberculous lymphadenopathy is an unusual complication of primary pulmonary tuberculosis. There are very few reports describing both CT and contrast swallow appearances of these lesions. OBJECTIVE To describe the CT and contrast swallow appearances of oesophageal erosion and perforation by lymphadenopathy as a complication of primary pulmonary tuberculosis in children. MATERIALS AND METHODS Imaging of three children with confirmed pulmonary tuberculosis and oesophageal perforation was retrospectively reviewed. RESULTS Tuberculosis was confirmed by culture in all three patients. Contrast swallow demonstrated a contained leak in two patients and a tracheo-oesophageal fistula in one. Two patients had mediastinal air and one patient had a mediastinal collection on CT. All patients had features diagnostic of pulmonary tuberculosis on CT. CONCLUSION The imaging features comprise leakage of contrast medium with or without fistula formation on contrast swallow, large low-density lymph nodes on CT, and mediastinal air. The use of retrievable stents is a promising idea in this condition.
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Affiliation(s)
- Anita Erlank
- Department of Radiology, Stellenbosch University Medical School, P.O. Box 19063, Tygerberg 7505, South Africa
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Goussard P, Sidler D, Kling S, Andronikou S, Rossouw GF, Gie RP. Esophageal stent improves ventilation in a child with a broncho-esophageal fistula caused by Mycobacterium tuberculosis. Pediatr Pulmonol 2007; 42:93-7. [PMID: 17133521 DOI: 10.1002/ppul.20532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The deployment of an esophageal stent to aid in the ventilation of a child who had developed an acquired broncho-esophageal fistula caused by Mycobacterium tuberculosis (MTB) is described. The 12-month-old boy presented with respiratory failure requiring ventilation. The air leak via the fistula led to inadequate mechanical ventilation. The deployment of the stent resulted in successful ventilation, closure of the fistula, and eventual successful treatment.
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Affiliation(s)
- P Goussard
- Department of Pediatrics and Child Health, University of Stellenbosch and Tygerberg Children's Hospital, Cape Town, South Africa.
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Yilmaz E, Akkoclu A, Sevinc C. CT and MRI appearance of a fistula between the right and left main bronchus caused by tracheobronchial tuberculosis. Br J Radiol 2001; 74:1056-8. [PMID: 11709473 DOI: 10.1259/bjr.74.887.741056] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis of the trachea and main bronchi is a relatively rare disease seen predominantly in elderly patients. We present a case of a fistula between the right and left main bronchus owing to tuberculosis. We describe the CT and MRI appearances.
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Affiliation(s)
- E Yilmaz
- Department of Radiology, Dokuz Eylül University Hospital, Izmir, 35340, Turkey
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Affiliation(s)
- R P Gie
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Stellenbosch, Tygerberg, South Africa
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