Tracheomegaly in children

Tracheobronchomegaly, cough and recurrent chest infection: Mounier-Kuhn syndrome

A 49-year-old male ex-smoker was referred for recurrent chest infections requiring one course of antibiotics every winter, occurring over the last 20 years. Each episode is characterised by a productive cough with purulent sputum along with difficulty breathing, chest tightness and fatigue, but without haemoptysis. On some occasions, these symptoms were preceded by fever and rhinorrhoea. Each episode lasted ∼10 days and responded well to antibiotics. He had never been hospitalised for these infections, nor received a chest radiograph or sputum microbiology. He had been told that he developed episodes of pneumonia in his first year of life. Apart from these yearly infections, the patient was asymptomatic during the rest of the year.

Mounier-Kuhn Syndrome (MKS) is a rare disease characterised by recurrent chest infections, and dilation of the trachea and main bronchi, most likely to due to atrophy of elastic fibreshttps://bit.ly/3azhDjr

Tracheal Diameter and Respiratory Outcome in Infants with Congenital Diaphragmatic Hernia Treated by Fetal Endoscopic Tracheal Occlusion

AIM

To evaluate tracheal diameters and their clinical impact in patients with congenital diaphragmatic hernia (CDH) after fetal endoscopic tracheal occlusion (FETO).

METHODS

Patients born with CDH between January 2012 and August 2016 were divided into two groups: noFETO and FETO. Tracheal diameters at three levels (T1, carina, and maximum tracheal dilation) on chest X-ray at 1, 3, 6, 12, 24, and 36 months of follow-up, requirements of invasive and noninvasive respiratory support, the incidence of respiratory infections, and results of pulmonary function tests (PFT) were compared.

RESULTS

A total of 71 patients with CDH were born in the study period, and there were 34/41 survivors in the no-FETO group (82.9%) and 13/30 in the FETO group (43.3%). The maximum tracheal diameter was significantly greater in the FETO group at all ages. No differences were observed in the diameters at T1 and the carina, in the requirements of invasive and noninvasive respiratory support, and in the incidence respiratory infections. At the PFT (6-12 months), the FETO group presented higher respiratory rates (46.1 ± 6.2 vs. 36.5 ± 10.6, p = 0.02). No differences in PFT results were found between the groups after the 1st year of life.

CONCLUSIONS

The FETO procedure leads to persistent tracheomegaly. However, the tracheomegaly does not seem to have a significant clinical impact.

A Clinical Classification Scheme for Tracheobronchomegaly (Mounier-Kuhn Syndrome)

INTRODUCTION

Tracheobronchomegaly (Mounier-Kuhn Syndrome) is a rare disease characterized by tracheal enlargement and associated loss of elastic fibers in the trachea and main bronchi.

MATERIALS

MEDLINE, Index Medicus, and other databases were searched with pre-defined criteria to identify cases of tracheobronchomegaly (TBM). Two new cases of TBM were also identified from the Provincial Medical Genetics Program of British Columbia.

RESULTS

We identified 166 publications describing 365 occurrences of TBM. We observed that affected individuals could be grouped into subgroups according to clinical features. Type 1A (105 individuals) consists of infants who developed TBM after having undergone fetoscopic tracheal occlusion, and Type 1B patients (24 individuals) are infants and children who developed TBM after prolonged intubation. Type 2 individuals developed TBM following recurrent pulmonary infections (2A) (14 individuals) or pulmonary fibrosis (2B) (10 individuals). Type 3 represents TBM with evidence of extra-pulmonary elastolysis (18 individuals), and Type 4 denotes the development of TBM with no clear predisposing factors (196 individuals). Both of our patients had TBM and evidence of extra-pulmonary elastolysis. As well, one patient had a mildly dilated aortic root, which is a previously unreported co-occurrence.

CONCLUSION

We introduce a novel classification scheme, which may sort patients into etiologically distinct groups, furthering our understanding of its pathogenesis and potentially, prevention or therapy. We also hypothesize that TBM and generalized elastolysis may have etiological commonalities, suggesting a need for further study.

[An unusual association: tracheobronchomegaly with a normal pulmonary function test]

Tracheobronchomegaly is a rare condition characterised by marked dilation of the trachea and the main bronchi. The clinical presentation of this disease is nonspecific and the diagnosis is based on the radiological features, especially computed tomography of chest. Pulmonary function tests are often abnormal showing airflow limitation with increased residual volume. The authors report a rare case of a 31-year-old man presenting tracheobronchomegaly is normal pulmonary function test.

Rapidly progressing case of Mounier-Kuhn Syndrome in early childhood

Reports of Mounier-Kuhn Syndrome in childhood are extremely rare, as it usually presents in the third or fourth decades. In the only other report of a case diagnosed in early childhood, the child was well at the time of publication. We report on a 15-month-old boy who presented with his first respiratory illness at age 3 months. His disease course was more severe than previously reported. Diagnosis was characteristically delayed until acute respiratory failure complicated a respiratory tract infection at 13 months, prompting high-resolution computerized tomography (HRCT) of the chest. He gradually deteriorated, eventually requiring ventilatory support; death occurred at age 15 months. This report illustrates the clinical heterogeneity of the syndrome. We review the theories about etiology and the recognized clinical findings in adults. Incidence may be higher than previously estimated, and tracheobronchomegaly (TBM) should be considered as a cause of respiratory failure and recurrent pneumonia in children where other investigations, including chest X-ray (CXR), are normal. A chest HRCT (cHRCT) scan and bronchoscopy are usually diagnostic.

Tracheobronchomegaly in preterm infants on mechanical ventilation

Tracheobronchomegaly (TBM) was diagnosed on chest radiographs as an apparent dilatation of the trachea and main bronchi in four premature infants on prolonged mechanical ventilation for respiratory distress syndrome. In a retrospective study, the parameters of assisted ventilation, the Apgar score, the presence of conatal or later infection, and hypotension were reviewed and analyzed as factors possibly contributing to the pathogenesis of TBM in these infants. The results lead to the conclusion that TBM in premature infants on prolonged ventilatory support is an acquired condition though a congenital defect cannot be excluded as a probable predisposing factor. In the etiopathogenesis of TBM, a repeated barotrauma of prolonged ventilation is a crucial factor while the severity of lung disease and the degree of prematurity, hypotension, infection, and generally poor clinical condition, all appear to be relevant in the development of TBM in a premature infant with respiratory distress syndrome.