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Xiong J, Zhou Q, Li Y, Sun Y, Zhang Y. Unexpected curious cause of serious air leakage after endotracheal intubation: A case report of tracheobronchomegaly and literature review. Front Surg 2022; 9:961186. [PMID: 36081585 PMCID: PMC9445417 DOI: 10.3389/fsurg.2022.961186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTracheobronchomegaly (TBM) is a rare disease with enlarged trachea and mainstem bronchi, which might not be diagnosed preoperatively because of patient’s nonsymptoms or clinicians’ overlook. These patients would be at fatal risk after general anesthesia endotracheal intubation due to severe peritubal leakage. This case may provide a helpful and informative resource for anesthesiologists and other clinicians, especially those managing patients’ airways.Clinical featureWe presented a patient undergoing elective scoliosis orthopedics who was postoperatively diagnosed with TBM. After general anesthesia endotracheal intubation, difficulty in maintaining ventilation with obvious peri-cuff air leakage made this rare disease to be suspected. The peritubal leakage was resolved by relocating the endotracheal tube to the subglottic area. Fortunately, there were no air leakage and postoperative complications.ConclusionAnesthesiologists should keep the possibility of the unpredicted anatomic abnormal respiratory tract in mind, such as TBM.
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Affiliation(s)
- Jun Xiong
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
- Correspondence: Jun Xiong
| | - Quan Zhou
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Yu Li
- Department of Radiology, Jiangsu Province Hospital of Integration of Chinese and Western Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yanyan Sun
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Yajun Zhang
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
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Aktaş F, Aktaş T. Volume Measurement in the Diagnosis of Mounier Kuhn Syndrome and an Unknown Accompanying Pathology: Pulmonary Artery Enlargement. Curr Med Imaging 2020; 15:796-801. [PMID: 32008547 DOI: 10.2174/1573405615666190220110628] [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: 08/27/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mounier Kuhn Syndrome (MKS) is a rare congenital anomaly characterized by abnormal dilatation of the trachea and main bronchi. The aim of this study is to discuss tracheal volume measurement in MKS, and the pathologies accompanying MKS, especially pulmonary artery enlargement. MATERIALS AND METHODS 38 patients, 18 of whom were diagnosed with MKS and 20 as control group, were included in the study. Trachea volume and pulmonary artery diameter were measured through thorax-computed tomography (CT) images of the patients. Accompanying pathologies were recorded. RESULTS In the measurements done through the CT scans, the trachea volume was found to be 25.45 cm3 in the control group and 44.17 cm3 in the patient group. The most frequent accompanying pathologies were tracheal diverticulum, bronchiectasis and pulmonary artery enlargement. CONCLUSION In patients with MKS, there is a significant difference in volume calculation as in trachea diameter. Though bronchiectasis and tracheal diverticulum are known as pathologies most frequently accompanying MKS, to the knowledge of the researchers, pulmonary artery enlargement due to the increase in pulmonary truncus diameter was first emphasized in this article.
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Affiliation(s)
- Fatma Aktaş
- Radiology Department, School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Turan Aktaş
- Pulmonary Diseases Department, VERSA Hospital, Nevsehir, Turkey
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Lima E, Nakamura MAM, Genta PR, Rodrigues AJ, Athanazio RA, Rached S, Costa ELV, Stelmach R. Improving Airways Patency and Ventilation Through Optimal Positive Pressure Identified by Noninvasive Mechanical Ventilation Titration in Mounier-Kuhn Syndrome: Protocol for an Interventional, Open-Label, Single-Arm Clinical Trial. JMIR Res Protoc 2020; 9:e14786. [PMID: 32795996 PMCID: PMC7455860 DOI: 10.2196/14786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. OBJECTIVE The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. METHODS This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). RESULTS This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers' availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. CONCLUSIONS There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a "pneumatic stent" to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation. TRIAL REGISTRATION ClinicalTrails.gov NCT03101059; https://clinicaltrials.gov/ct2/show/NCT03101059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14786.
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Affiliation(s)
- Evelise Lima
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | | | - Pedro Rodrigues Genta
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Ascedio José Rodrigues
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Rodrigo Abensur Athanazio
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Samia Rached
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division-Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
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Dosanjh A. Airway Malformations and Bronchiectasis: A Pediatric Study. EAR, NOSE & THROAT JOURNAL 2019; 99:44-46. [PMID: 30974997 DOI: 10.1177/0145561319839606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital airway malformations are most often identified in early childhood. The development of bronchiectasis in association with malformations of the lower airway has been described, particularly among adult patients. The coexistence in a pediatric population of these conditions is not well described. This study was conducted to identify whether younger patients with airway malformations commonly develop bronchiectasis. International Classification of Diseases, Ninth revision (ICD-9 codes) were defined for airway anomalies and bronchiectasis. The electronic medical records system of a children's hospital was then searched for the number of patients with upper airway anomalies with or without bronchiectasis. The airway database was then cross referenced with the ICD codes for bronchiectasis to identify patients with both conditions. There were 844 patients with airway anomalies and 117 with bronchiectasis in the electronic system during the time period of August 1, 2009 to September 30, 2014. There was only 3 patients identified with both bronchiectasis and airway anomalies. The coexistence of bronchiectasis is low among the pediatric population with upper airway anomalies studied. This would suggest that the children with airway anomalies have been treated with strategies that are effective in the prevention of recurrent lower respiratory tract infection. Further study may be done to define the effectiveness of various strategies in preventing aspiration and lower respiratory tract infection. In addition, this methodologic technique utilizing database integrative platforms is useful in the identification of patients for further study and to identify the coexistence of pediatric conditions.
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Shroff GS, Ocazionez D, Vargas D, Carter BW, Wu CC, Nachiappan AC, Gupta P, Restrepo CS. Pathology of the Trachea and Central Bronchi. Semin Ultrasound CT MR 2016; 37:177-89. [DOI: 10.1053/j.sult.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Schmitt P, Dalar L, Jouneau S, Toublanc B, Camuset J, Chatte G, Cellerin L, Dutau H, Sanchez S, Sauvage M, Vergnon JM, Dury S, Deslée G, Lebargy F. Respiratory Conditions Associated with Tracheobronchomegaly (Mounier-Kuhn Syndrome): A Study of Seventeen Cases. Respiration 2016; 91:281-7. [PMID: 27022925 DOI: 10.1159/000445029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by enlargement of the trachea and main bronchi and associated with recurrent respiratory tract infections. OBJECTIVE This multicenter, retrospective study was carried out to describe respiratory conditions associated with tracheobronchomegaly. METHODS Nine institutions involved in the 'Groupe d'Endoscopie de Langue Française' (GELF) participated in this study. A standard form was used to record patient characteristics, treatments and follow-up from medical charts. RESULTS Seventeen patients, 53% male, aged 58 ± 18 years at diagnosis were included. Recurrent infections revealed MKS in 88% of cases. Main comorbid conditions were diffuse bronchiectasis in 88% of patients and tracheobronchomalacia in 67% of cases. The exacerbation rate was 1.5 exacerbations/patient/year. The main non-respiratory morbid condition was gastroesophageal reflux disease in 29% of cases. Interventional bronchoscopy was performed in seven patients (41%), consisting of laser (n = 2) and tracheal stenting (n = 5). Complications related to stents were observed in 80% of cases with a mean stent duration of 8 months. Four deaths, including three due to respiratory causes, occurred during follow-up. CONCLUSIONS This is the largest series of MKS reported in the literature, showing that bronchiectasis and tracheobronchomalacia are the main associated morbid conditions that constitute a challenge for treatment.
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Affiliation(s)
- Pierre Schmitt
- Department of Respiratory Medicine, University Hospital Maison Blanche, Reims, France
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Lerner C, Patel R, Julka K. The man with the large trachea: Mounier-Kuhn syndrome. Am J Med 2014; 127:1072-1074. [PMID: 25004454 DOI: 10.1016/j.amjmed.2014.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Charles Lerner
- Department of Internal Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX.
| | - Raj Patel
- Sarver Heart Center, University of Arizona, Tucson
| | - Karan Julka
- Athens Pulmonary and Sleep Medicine, Athens, GA
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Krustins E. Mounier-Kuhn syndrome: a systematic analysis of 128 cases published within last 25 years. CLINICAL RESPIRATORY JOURNAL 2014; 10:3-10. [DOI: 10.1111/crj.12192] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/03/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Eduards Krustins
- Department of Internal Medicine; Pauls Stradins Clinical University Hospital; Riga Latvia
- Department of Internal Medicine; Riga Stradins University; Riga Latvia
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Krustins E, Kravale Z, Buls A. Mounier-Kuhn syndrome or congenital tracheobronchomegaly: a literature review. Respir Med 2013; 107:1822-8. [PMID: 24070565 DOI: 10.1016/j.rmed.2013.08.042] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/13/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a chronic airway condition which for currently unknown reasons mostly affects males. It is commonly overlooked on conventional chest X-rays, and is considered to be rare, but the prevalence might be higher as commonly assumed. The hallmark of it is a dilatation of the main airways which frequently, but not always, causes marked, mainly respiratory, symptoms, and patients usually present with varying degrees of recurrent infections, breathlessness, haemoptysis, dyspnoea. Although at least 200 case reports have been published, there have been only a few attempts to review them, and none in the last 20 years. Due to the lack of clinical trials and wide variability of case-report format, a systematic review was deemed not feasible, therefore PubMed and Medline databases were searched using terms "Mounier-Kuhn syndrome", "tracheobronchomegaly", "tracheomegaly", and "bronchomegaly", without any time restrictions, to summarize currently known facts about the syndrome. To the authors' best knowledge, the result is currently the most comprehensive review of previously published literature about the congenital tracheobronchomegaly, and summarizes what's known about symptoms, prevalence, disease associations, and treatment options for this syndrome.
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Affiliation(s)
- Eduards Krustins
- Centre of Pulmonary Diseases, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga LV1002, Latvia.
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Dutau H, Maldonado F, Breen DP, Colchen A. Endoscopic successful management of tracheobronchomalacia with laser: apropos of a Mounier-Kuhn syndrome. Eur J Cardiothorac Surg 2011; 39:e186-8. [DOI: 10.1016/j.ejcts.2011.01.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 12/28/2010] [Accepted: 01/26/2011] [Indexed: 10/18/2022] Open
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Aspiration, Bronchial Obstruction, Bronchiectasis, and Related Disorders. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7121473 DOI: 10.1007/978-0-387-68792-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The conducting airways play a pivotal role in the spectrum of pulmonary pathology, not only as conduits for injurious agents to enter the lung, but also as an anatomic compartment that is affected by a diverse array of primary or secondary bronchocentric diseases. This chapter discusses aspiration and bronchial obstruction in detail, with emphasis on the aspiration of toxic, infective, or particulate matter. Lung abscess, a frequent complication of obstruction or aspiration, is also reviewed. Both aspiration and lung abscess are reconsidered within the context of pulmonary infectious disease mainly in Chapter 8 on bacterial infections, and to some extent in the chapters on mycobacterial (Chapter 9), fungal (Chapter 10), and parasitic diseases (Chapter 14).
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Heckmann M, Uder M, Kramann B, Heinrich M. [Differential diagnosis of bronchiectasis: high-resolution CT as a valuable aide]. RONTGENPRAXIS; ZEITSCHRIFT FUR RADIOLOGISCHE TECHNIK 2006; 56:39-46. [PMID: 16733995 DOI: 10.1016/j.rontge.2005.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bronchiectasis is defined as localized irreversible dilatation of the bronchial tree. Brochiectasis has been associated with a wide variety of causes, but it is mostly caused by acute, chronic or recurrent infections. This paper should give a review about the manifestation of bronchiectasis and bronchioloectasis in HR-CT and discuss the causing entities. However, integration of bronchiectasis and other HR-CT findings may enable a narrower differential diagnosis, in some cases it is possible to give the correct diagnose directly.
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Affiliation(s)
- Martina Heckmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Kara ME, Turan E, Dabanoglu I, Ocal MK. Computed tomographic assessment of the trachea in the german shepherd dog. Ann Anat 2004; 186:317-21. [PMID: 15481838 DOI: 10.1016/s0940-9602(04)80048-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Computed tomographic (CT) examination of the trachea was performed in 10 German shepherd dogs to determine the normal value of some tracheal measurements under general anesthesia and in sternal recumbence position. Measurements obtained from nine segments were evaluated in four groups as the cranial cervical, caudal cervical, thoracic inlet and the thoracal tracheas. The inner transverse (T) and vertical (V) diameters were measured with the aid of electronic calipers from the software of the CT scanner. The cross-sectional lumen area (CSA) was calculated by using vertical and transverse diameters. The ratio of the transverse and vertical diameters (T/V) was also calculated. There was not any significant difference between thoracic inlet and thoracic tracheas, however, the mentioned regions were found to be significantly different from both cranial and caudal cervical regions in all measurements except the ratio of T/V. The ratio of T/V between 0.92 and 1.06 gradually changed and there was not any statistical difference between subsequent regions while differences were found among further regions. The largest CSA, seen in cranial cervical trachea was as 364.62 mm2 and decreased gradually to 309.29, 245.69 and 226.50 mm2 in caudal cervical, thoracic inlet and thoracic tracheas, respectively. From the point of view of technique, CT examination of the dog trachea was very easy and it was possible to take sensitive and repeated measurements. It, however, may be accepted as expensive and that it is disadvantageous to require general anesthesia. The data presented in this study represent tracheal values in the healthy German shepherd dog under the conditions of the study.
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Affiliation(s)
- Mehmet Erkut Kara
- Adnan Menderes University, Veterinary Faculty, Department of Anatomy, PK: 17 09016 Isikli, Aydin/Turkey.
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Oppermann HC. Fehlbildungen. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nóbrega BBD, Figueiredo SDS, Cavalcante LP, Ribeiro RE, Teixeira KISS. Traqueobroncomegalia (síndrome de Mounier-Kuhn): relato de caso e revisão da literatura. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000300012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A traqueobroncomegalia é uma rara entidade de etiologia incerta, caracterizada por dilatação marcante da traquéia e brônquios principais, bronquiectasias e infecções recorrentes do trato respiratório inferior. Sua apresentação clínica é inespecífica, sendo o diagnóstico realizado por métodos de imagem. Relata-se, neste trabalho, um caso de tal enfermidade, cujo diagnóstico confirmou-se por radiografia simples do tórax e por tomografia computadorizada.
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Abstract
Bronchiectasis is becoming less common as the treatment for acute lower respiratory tract infections improves and immunization programmes decrease the frequency of pertussis and measles. However bronchiectasis is still a challenge to the paediatric chest physicians in many developing parts of the world and it remains a frequent problem being the final common pathway of several different lower respiratory tract insults such as cystic fibrosis, immunodeficiency, ciliary dyskinesia. Although the treatment of patients with bronchiectasis is primarily medical, surgical treatment is required in a small group of patients with recurrent episodes of pneumonia and atelectasis localized to one area, severe or recurrent hemoptysis and in those unresponsive to aggressive medical treatment with abnormal growth and development. There are unanswered questions about childhood bronchiectasis, mainly on aetiology and treatment which require more research.
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Affiliation(s)
- E Dagli
- Department of Paediatric Pulmonology, Marmara University, Altunizade, Istanbul 81190, Turkey.
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