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Lee EY, Xu L, Liszewski MC, Foust AM, Williams-Weekes T, Winant AJ. Respiratory Distress in Children: Review and Update of Imaging Assessment. Semin Roentgenol 2024; 59:267-277. [PMID: 38997181 DOI: 10.1053/j.ro.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Boston, MA.
| | - Limin Xu
- Greensboro Radiology, Greensboro, NC
| | - Mark C Liszewski
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M Foust
- Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Boston, MA
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Mikami Y, Grubb BR, Rogers TD, Dang H, Asakura T, Kota P, Gilmore RC, Okuda K, Morton LC, Sun L, Chen G, Wykoff JA, Ehre C, Vilar J, van Heusden C, Livraghi-Butrico A, Gentzsch M, Button B, Stutts MJ, Randell SH, O’Neal WK, Boucher RC. Chronic airway epithelial hypoxia exacerbates injury in muco-obstructive lung disease through mucus hyperconcentration. Sci Transl Med 2023; 15:eabo7728. [PMID: 37285404 PMCID: PMC10664029 DOI: 10.1126/scitranslmed.abo7728] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
Unlike solid organs, human airway epithelia derive their oxygen from inspired air rather than the vasculature. Many pulmonary diseases are associated with intraluminal airway obstruction caused by aspirated foreign bodies, virus infection, tumors, or mucus plugs intrinsic to airway disease, including cystic fibrosis (CF). Consistent with requirements for luminal O2, airway epithelia surrounding mucus plugs in chronic obstructive pulmonary disease (COPD) lungs are hypoxic. Despite these observations, the effects of chronic hypoxia (CH) on airway epithelial host defense functions relevant to pulmonary disease have not been investigated. Molecular characterization of resected human lungs from individuals with a spectrum of muco-obstructive lung diseases (MOLDs) or COVID-19 identified molecular features of chronic hypoxia, including increased EGLN3 expression, in epithelia lining mucus-obstructed airways. In vitro experiments using cultured chronically hypoxic airway epithelia revealed conversion to a glycolytic metabolic state with maintenance of cellular architecture. Chronically hypoxic airway epithelia unexpectedly exhibited increased MUC5B mucin production and increased transepithelial Na+ and fluid absorption mediated by HIF1α/HIF2α-dependent up-regulation of β and γENaC (epithelial Na+ channel) subunit expression. The combination of increased Na+ absorption and MUC5B production generated hyperconcentrated mucus predicted to perpetuate obstruction. Single-cell and bulk RNA sequencing analyses of chronically hypoxic cultured airway epithelia revealed transcriptional changes involved in airway wall remodeling, destruction, and angiogenesis. These results were confirmed by RNA-in situ hybridization studies of lungs from individuals with MOLD. Our data suggest that chronic airway epithelial hypoxia may be central to the pathogenesis of persistent mucus accumulation in MOLDs and associated airway wall damage.
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Affiliation(s)
- Yu Mikami
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Barbara R. Grubb
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Troy D. Rogers
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Takanori Asakura
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Pradeep Kota
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rodney C. Gilmore
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kenichi Okuda
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lisa C. Morton
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ling Sun
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gang Chen
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jason A. Wykoff
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Camille Ehre
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Juan Vilar
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Catharina van Heusden
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Martina Gentzsch
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brian Button
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - M. Jackson Stutts
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Scott H. Randell
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Gao Q, Ji H, Wu Z, Zhao P. Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young infants: A randomised controlled trial. J Clin Anesth 2023; 86:111075. [PMID: 36796214 DOI: 10.1016/j.jclinane.2023.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pneumoperitoneum is a risk factor for perioperative atelectasis in infants. This research aimed to investigate whether lung recruitment manoeuvres guided by ultrasound are more effective for young infants (<3 months) during laparoscopy under general anaesthesia. METHODS Young infants (<3 months) undergoing general anaesthesia during laparoscopic surgery (>2 h) were randomised to either conventional lung recruitment (control group) or ultrasound-guided lung recruitment (ultrasound group) once per hour. Mechanical ventilation was started with a tidal volume of 8 mL·kg-1, positive end-expiratory pressure of 6 cm H2O and 40% inspired oxygen fraction. Lung ultrasound (LUS) was performed four times (T1 was performed 5 min after intubation and before pneumoperitoneum set, T2 was performed after pneumoperitoneum, T3 was performed 1 min after surgery, and T4 was performed before being discharged from post-anaesthesia care unit [PACU]) in each infant. The primary outcome was the incidence of significant atelectasis at T3 and T4 (defined by LUS consolidation score ≥ 2 in any region). RESULTS 62 babies were enrolled in the experiment and 60 infants were included in the analysis. Before the recruitment, atelectasis was similar between infants randomised to the control or ultrasound group at T1 (83.3% vs 80.0%; P = 0.500) and T2 (83,3% vs 76.7%; P = 0.519). The incidence of atelectasis at T3 and T4 were lower in the ultrasound group (26.7% and 33.3%), compared with infants randomised to conventional lung recruitment (66.7% and 70%) (P = 0.002; P = 0.004; respectively). CONCLUSIONS Ultrasound-guided alveolar recruitment reduced the perioperative incidence of atelectasis in infants <3 months during laparoscopy under general anaesthesia.
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Affiliation(s)
- Qiushi Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haiyin Ji
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Talukdar SN, Osan J, Ryan K, Grove B, Perley D, Kumar BD, Yang S, Dallman S, Hollingsworth L, Bailey KL, Mehedi M. RSV-induced expanded ciliated cells contribute to bronchial wall thickening. Virus Res 2023; 327:199060. [PMID: 36746339 PMCID: PMC10007709 DOI: 10.1016/j.virusres.2023.199060] [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: 11/20/2022] [Revised: 01/02/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
Viral infection, particularly respiratory syncytial virus (RSV), causes inflammation in the bronchiolar airways (bronchial wall thickening, also known as bronchiolitis). This bronchial wall thickening is a common pathophysiological feature in RSV infection, but it causes more fatalities in infants than in children and adults. However, the molecular mechanism of RSV-induced bronchial wall thickening remains unknown, particularly in healthy adults. Using highly differentiated pseudostratified airway epithelium generated from primary human bronchial epithelial cells, we revealed RSV-infects primarily ciliated cells. The infected ciliated cells expanded substantially without compromising epithelial membrane integrity and ciliary functions and contributed to the increased height of the airway epithelium. Furthermore, we identified multiple factors, e.g., cytoskeletal (ARP2/3-complex-driven actin polymerization), immunological (IP10/CXCL10), and viral (NS2), contributing to RSV-induced uneven epithelium height increase in vitro. Thus, RSV-infected expanded cells contribute to a noncanonical inflammatory phenotype, which contributes to bronchial wall thickening in the airway, and is termed cytoskeletal inflammation.
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Affiliation(s)
- Sattya N Talukdar
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Jaspreet Osan
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Ken Ryan
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Bryon Grove
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Danielle Perley
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Bony D Kumar
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Shirley Yang
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Sydney Dallman
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Lauren Hollingsworth
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Kristina L Bailey
- Department of Internal Medicine, Pulmonary, Critical Care and Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Masfique Mehedi
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States.
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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [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: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Han Y, Pan F, Song H, Luo R, Li C, Pi H, Wang J, Li T. Intelligent injury prediction for traumatic airway obstruction. Med Biol Eng Comput 2023; 61:139-153. [PMID: 36331757 DOI: 10.1007/s11517-022-02706-w] [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: 05/23/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
Airway obstruction is one of the crucial causes of death in trauma patients during the first aid. It is extremely challenging to accurately treat a great deal of casualties with airway obstruction in hospitals. The diagnosis of airway obstruction in an emergency mostly relies on the medical experience of physicians. In this paper, we propose the feature selection approach genetic algorithm-mean decrease impurity (GA-MDI) to effectively minimize the number of features as well as ensure the accuracy of prediction. Furthermore, we design a multi-modal neural network, called fully convolutional network with squeeze-and-excitation and multilayer perceptron (FCN-SE + MLP), to help physicians to predict the severity of airway obstruction. We validate the effectiveness of the proposed feature selection approach and multi-modal model on the emergency medical database from the Chinese General Hospital of the PLA. The experimental results show that GA-MDI outperforms the existing feature selection algorithms, while it is also validated that the model FCN-SE + MLP can effectively and accurately achieve the prediction of the severity of airway obstruction, which can assist clinicians in making treatment decisions for airway obstruction casualties.
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Affiliation(s)
- Youfang Han
- School of Software, Tsinghua University, Beijing, China
| | - Fei Pan
- Emergency Department, The First Medical Center of PLA General Hospital, Beijing, China
| | - Hainan Song
- Emergency Department, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ruihong Luo
- School of Software, Tsinghua University, Beijing, China
| | - Chunping Li
- School of Software, Tsinghua University, Beijing, China.
| | - Hongying Pi
- Nursing Department, PLA General Hospital, Beijing, China.
| | - Jianrong Wang
- Nursing Department, PLA General Hospital, Beijing, China.
| | - Tanshi Li
- Emergency Department, The First Medical Center of PLA General Hospital, Beijing, China
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7
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Teo SS, Cheng A, Melvin D, Ng K, Harris J. Lateral airways X-ray with a history of choking. J Paediatr Child Health 2022. [PMID: 36468502 DOI: 10.1111/jpc.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Stephen Ss Teo
- Paediatrics Department, Blacktown and Mount Druitt Hospital, Sydney, New South Wales, Australia
- Emergency Department, Blacktown and Mount Druitt Hospital, Sydney, New South Wales, Australia
- Paediatrics Department, Western Sydney University, Sydney, New South Wales, Australia
| | - Alan Cheng
- Ear, Nose and Throat Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Melvin
- Emergency Department, Blacktown and Mount Druitt Hospital, Sydney, New South Wales, Australia
| | - Karen Ng
- Medical Imaging, Blacktown and Mount Druitt Hospital, Sydney, New South Wales, Australia
| | - Jodie Harris
- Emergency Department, Hawkesbury District Health Service, Sydney, New South Wales, Australia
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Talukdar SN, Osan J, Ryan K, Grove B, Perley D, Kumar BD, Yang S, Dallman S, Hollingsworth L, Bailey KL, Mehedi M. RSV-induced Expanded Ciliated Cells Contribute to Bronchial Wall Thickening.. [DOI: 10.1101/2022.10.31.514471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractViral infection, particularly respiratory syncytial virus (RSV), causes inflammation in the bronchiolar airways (bronchial wall thickening, also known as bronchiolitis), reducing airflow through the bronchioles. This bronchial wall thickening is a common pathophysiological feature in RSV infection, but it causes more fatalities in infants than in children and adults. However, the molecular mechanism of RSV-induced bronchial wall thickening remains unknown, particularly in healthy adults. RSV infection in the airway epithelium of healthy adult bronchial cells reveals RSV-infects primarily ciliated cells. RSV infection expands the cell cytoskeleton substantially without compromising epithelial membrane integrity and ciliary functions. The RSV-induced actin cytoskeleton expansion increases ununiformly epithelial height, and cytoskeletal (actin polymerization), immunological (INF-L1, TNF-α, IP10/CXCL10), and viral (NS2) factors are probably responsible. Interestingly, RSV-infected cell cytoskeleton’s expansion resembles a noncanonical inflammatory phenotype, which contributes to bronchial wall thickening, and is termed cytoskeletal inflammation.Author SummaryRSV infects everyone. Although RSV-induced fatal pathophysiology (e.g., bronchiolitis) is more common in infants than adults, this bronchiolitis (or bronchial wall thickening) is common in the lower respiratory tract due to RSV infection in all ages. To determine the molecular mechanism of RSV-induced bronchial wall thickening, we infectedin vitroadult airway epithelium with RSV. We found that RSV-infection induced a substantial actin-cytoskeleton expansion, consequently increased the height of the epithelium. We identified actin polymerization, secretion of proinflammatory cytokines and chemokines, and viral proteins contribute to the RSV-induced cytoskeletal expansion. Our results suggest that RSV-induces a novel noncanonical epithelial host response termed cytoskeletal inflammation, which may contribute to bronchial wall thickening.
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Development and Application of AR-Based Assessment System for Infant Airway Obstruction First Aid Training. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111622. [PMID: 36360350 PMCID: PMC9688683 DOI: 10.3390/children9111622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
Airway obstruction refers to suffocation caused by blockage of the airway due to a foreign body and is a common cause of accidental death in infants below one year of age. However, the current infant CPR manikins used for training in first aid for foreign body airway obstruction can only be applied to one single scenario. Furthermore, trainees' first aid skills cannot be recorded and quantified with a digital system and, consequently, assessment of their skills is difficult to conduct. This study aims to overcome the technical limitations by developing an AR-based assessment system for training in first aid for infant airway obstruction. With this assessment system, trainees can learn first aid more efficiently and correctly and conduct a quantitative assessment of their skills digitally. For instructors, the time required for assessment, potential human error, and the cost of training can also be reduced. The system can be a practical learning tool that helps trainees assess emergencies and integrate their knowledge and skills.
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Kim Y, Park JE, Kim JH. Plain Radiographic Analysis of Laryngeal Dimensions in Young Children: Normal versus Croup. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101532. [PMID: 36291468 PMCID: PMC9600057 DOI: 10.3390/children9101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/16/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
(1) Background: Contrary to a tenet of the funnel-shaped pediatric larynx with the cricoid level being narrowest, recent studies show the glottis and subglottis as the narrowest levels. To locate the functionally narrowest level of the larynx, we reported normal laryngeal dimensions and their croup-related changes in young children. (2) Methods: We reviewed normal plain neck radiographs recorded for the evaluation of minor trauma or foreign bodies in 504 children aged ≤4 years who visited the emergency department from 2016 through 2021. Using computed tomography-based localization of the glottis, we radiographically defined the subglottis and cricoid. At these levels, we measured diameters and calculated cross-sectional areas (CSAs) on the radiographs. The values were compared to the equivalent values of a 1:1 age-matched population with croup. (3) Results: In the study population (n = 401), the narrowest diameter and CSA were observed in the glottis. In detail, the mean anteroposterior/transverse diameters were 9.8/3.4 mm at the glottis, 8.5/5.6 mm at the subglottis, and 7.4/6.8 mm at the cricoid (p < 0.001), respectively. In the same order, the mean CSAs were 26.5, 38.1, and 40.5 mm2 (p < 0.001). All dimensions were narrower in the croup population (p < 0.001). We found croup-related narrowing, namely reductions in the transverse diameter and CSA that were more severe closer to the glottis (p < 0.001), without differences per level in the anteroposterior diameter. (4) Conclusions: This study confirms the glottis as the narrowest level of the larynx in young children. In addition, level-based differences in croup-related narrowing suggest some point between the glottis and subglottis as the functionally narrowest level.
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Affiliation(s)
- Youngdae Kim
- Departments of Emergency Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea
| | - Ji-Eun Park
- Departments of Radiology, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea
| | - Jung-Heon Kim
- Departments of Emergency Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea
- Correspondence: ; Tel.: +82-31-219-7750
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Markovitz M, Monforte H, Shieh HF, Smithers CJ, Kucera JN. Endobronchial mucoepidermoid carcinoma in a pediatric patient: A case report. Radiol Case Rep 2022; 17:2034-2037. [PMID: 35432680 PMCID: PMC9010688 DOI: 10.1016/j.radcr.2022.03.043] [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: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is an uncommon type of salivary gland tumor that can present as an endobronchial neoplasm, most commonly in the adult population. Neuroendocrine carcinoid tumors comprise the majority of bronchial neoplasms in the pediatric population and are nearly indistinguishable from MEC on imaging. We present a rare case of MEC in a 3-year-old presenting with recurrent symptoms of lower airway obstruction and discuss its typical associated symptoms and imaging features.
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Affiliation(s)
- Michael Markovitz
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA
- Corresponding author.
| | - Hector Monforte
- Department of Pathology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Hester F. Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | | | - Jennifer Neville Kucera
- Department of Radiology, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL STC 6102, USA
- Department of Radiology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
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12
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Nair AD, Manchanda S, Kairo A, Bhalla AS. Diagnostic dilemma in an infant with stridor: ultrasound to the rescue! Emerg Radiol 2022; 29:929-932. [PMID: 35622203 DOI: 10.1007/s10140-022-02064-y] [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: 04/02/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Stridor is one of the most important signs of partial or complete upper airway obstruction. Subglottic hemangioma (SGH) is a well-recognized however infrequent cause of infantile stridor. It is a potentially life-threatening condition. Thus, early diagnosis and management are crucial. Diagnostic evaluation includes ultrasound, cross-sectional imaging such as contrast-enhanced CT/MRI, and tracheobronchoscopy. Ultrasound (US), although not a widely used modality for the diagnosis, provides good assessment of its presence, extent, and degree of subglottic airway narrowing. Moreover, color Doppler helps to establish the vascular nature of the lesion. There are many advantages of US over tracheobronchoscopy and CT in an emergency setting which include its easy availability, non-invasive nature, and can be done quickly as a bedside procedure, enabling early initiation of treatment. However, there are some disadvantages as well, which include limited field of view and operator dependency. Also, extension into the thoracic cavity and more deeply located soft tissue locations can be missed. We present a case of subglottic hemangioma in which US solved the diagnostic dilemma and provided a definite diagnosis when CT and tracheobronchoscopy failed to do so in a 6-month-old infant presenting with stridor to the ER.
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Affiliation(s)
- Ankita Dhiman Nair
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No. 81c, New Delhi, 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No. 81c, New Delhi, 110029, India.
| | - Arvind Kairo
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No. 81c, New Delhi, 110029, India
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13
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Successful Management Foreign Body Aspiration Associated with Severe Respiratory Distress and Subcutaneous Emphysema: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58030396. [PMID: 35334572 PMCID: PMC8955108 DOI: 10.3390/medicina58030396] [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: 02/14/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after aspiration of a foreign body, followed by severe respiratory distress and subcutaneous emphysema. Chest radiography revealed hyperinflation data, pneumothorax, and subcutaneous emphysema data. The flexible bronchoscope examination showed the presence of an inorganic foreign body impacted on the carina with tracheal lesions and laryngeal edema. It was necessary to perform a tracheostomy for its definitive extraction. The gold standard in the treatment of foreign body aspiration is bronchoscopy; although, in children, the technique adopted continues to be controversial, flexible bronchoscopy can be effective and very useful.
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Fayon M, Beaufils F. The lower respiratory airway wall in children in health and disease. ERJ Open Res 2021; 7:00874-2020. [PMID: 34322550 PMCID: PMC8311136 DOI: 10.1183/23120541.00874-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Alone or in association with other lung or thorax component disorders, the airway wall (AWW) remains one of the most frequently involved elements in paediatric lung diseases. A myriad of AWW disorders will present with similar symptomatology. It is thus important for the clinician to reappraise the normal development and structure of the AWW to better understand the underlying disease patterns. We herein provide an overview of the structure of the AWW and a description of its development from the fetal period to adulthood. We also detail the most common AWW changes observed in several acute and chronic respiratory disorders as well as after cigarette smoke or chronic pollution exposure. We then describe the relationship between the AWW structure and lung function. In addition, we present the different ways of investigating the AWW structure, from biopsies and histological analyses to the most recent noninvasive airway (AW) imaging techniques. Understanding the pathophysiological processes involved in an individual patient will lead to the judicious choice of nonspecific or specific personalised treatments, in order to prevent irreversible AW damage.
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Affiliation(s)
- Michael Fayon
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux Imaging Center, Bordeaux, France
- CHU de Bordeaux, Département de Pédiatrie, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France
- INSERM, Centre d'Investigation Clinique (CIC1401), Bordeaux, France
| | - Fabien Beaufils
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux Imaging Center, Bordeaux, France
- CHU de Bordeaux, Département de Pédiatrie, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France
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15
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Sago T, Watanabe K, Kawabata K, Shiiba S, Maki K, Watanabe S. A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation. J Oral Maxillofac Surg 2021; 79:539-545. [DOI: 10.1016/j.joms.2020.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
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16
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Vehapoğlu A, Çakır E, Uzuner S, Çalım ÖF, Yazan H. A Rare Presentation of Acquired Laryngomalacia and Tracheomalacia in a Child Associated with Apricot Sulfurization. Turk Arch Otorhinolaryngol 2021; 58:286-288. [PMID: 33554206 DOI: 10.5152/tao.2020.5398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022] Open
Abstract
Sulfur fumigation has come to replace traditional sun drying methods for drying fruits over the years around the world as it is a cheaper and faster method because of its pesticidal and anti-bacterial properties. We report the case of an 11-year-old boy with acquired severe biphasic stridor who was exposed to extremely high concentrations of sulfur dioxide (SO2) during apricot sulfurization processes with his mother. The patient's bronchoscopy revealed severe glottic and subglottic damage. Exposure to SO2 is a health risk, particularly for individuals who are sulfide-sensitive, especially in childhood. The pulmonary epithelium may be directly injured by inhaled toxic substances at various levels of the respiratory system. To the best of our knowledge, this is the first case reported of acquired airway damage associated with sulfurization in a pediatric patient without a known history of any respiratory disease or symptoms.
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Affiliation(s)
- Aysel Vehapoğlu
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Selçuk Uzuner
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Ömer Faruk Çalım
- Department of Otorhinolaryngology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
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17
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Abeles M, Akerman M, Halaby C, Pirzada M. Do subtle findings on chest X-ray predict worse outcomes for paediatric asthma? Postgrad Med J 2020; 98:183-186. [PMID: 33273110 DOI: 10.1136/postgradmedj-2020-139165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Asthma, a common childhood condition, often presents with chronic cough. While evaluating for chronic cough, many specialists obtain a baseline chest radiograph (CR) to assess for other causes. Usually read as 'normal', sometimes CRs will reveal evidence of airway inflammation in the form of subtle findings, such as 'increased interstitial markings' or 'peribronchial thickening'. There is sparse literature in the outpatient setting correlating findings on baseline CRs with adverse outcomes such as systemic steroid use, emergency department (ED) visit or hospitalisation. METHODS This was a retrospective study of patients seen at our institution's Pediatric Pulmonology outpatient clinic. We reviewed the charts of all new patients aged 0-18 years who presented between January 2015 and December 2017. Patients were included if they were diagnosed with asthma, had a CR after the initial visit and were followed up at least twice. Adverse outcomes include systemic steroid use, ED visit or hospitalisation. RESULTS 130 subjects were included. 89 subjects had clear CRs and 41 subjects had CRs with airway inflammation. Overall events were higher in the airway inflammation group (22.5% vs 46.3%, respectively, p<0.0058). There were no significant differences between in terms of oral corticosteroid use or hospitalisations. There was a significant difference between the two groups in terms of ED visits (2.2% vs 14.6%, respectively, p=0.0121). CONCLUSION This study shows a positive correlation between airway inflammation findings on baseline CR and subsequent ED visits in patients with asthma.
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Affiliation(s)
- Michael Abeles
- Pediatric Pulmonology, NYU Winthrop Hospital, Mineola, New York, USA
| | | | - Claudia Halaby
- Pediatric Pulmonology, NYU Winthrop Hospital, Mineola, New York, USA
| | - Melodi Pirzada
- Pediatric Pulmonology, NYU Winthrop Hospital, Mineola, New York, USA
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18
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Villemure-Poliquin N, Chénard-Roy J, Lachance S, Leclerc JE, Lemaire-Lambert A. Necrotizing epiglottitis with necrotizing fasciitis in a child: A case report and review of literature. Int J Pediatr Otorhinolaryngol 2020; 138:110385. [PMID: 33152976 DOI: 10.1016/j.ijporl.2020.110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/15/2022]
Abstract
Necrotizing epiglottitis (NE) is a rare but extremely serious variant of acute bacterial epiglottitis. So far, it has been reported mostly in immunocompromised adults and only seldomly in the pediatric population. We describe the case of a 15-month-old immunocompetent child who presented to our tertiary referral center with necrotizing epiglottitis. This manuscript emphasizes the need for rapid recognition and surgical management of this unusual condition, as well as the importance of laryngeal preservation when facing overwhelming necrosis around the laryngeal cartilaginous framework. A review of the literature using MEDLINE, Embase and Web of Science databases was performed to discuss the epidemiology, bacteriology, treatment and prognosis of NE.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
| | - Jade Chénard-Roy
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Lachance
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Jacques E Leclerc
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Anthony Lemaire-Lambert
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
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19
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Lee MJ, Shin HJ, Yoon H. Imaging of Acute Pulmonary and Airway Diseases in Children. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:756-769. [PMID: 36238171 PMCID: PMC9432207 DOI: 10.3348/jksr.2020.81.4.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
소아의 다양한 응급질환 중 급성 폐질환 또는 급성 기도질환은 영상의학과 의사가 자주 대하게 되는 임상 상황이며, 일차적으로 시행되는 영상검사는 흉부 방사선사진이다. 따라서 다양한 임상 상황에서의 감별진단과 영상 소견을 숙지하는 것이 중요하다. 본 종설에서는 급성 폐질환의 다양한 원인과 폐렴을 알아보고, 폐렴과 감별해야 하는 급성 폐질환을 생각해보았다. 급성 기도질환으로는 크룹, 급성 후두염, 기관연화증, 천식, 감염 후 폐쇄세기관지염, 그리고 이물 흡인을 검토하였다. 이렇게 소아에서 고려해야 할 질환들의 영상 소견을 검토하여 진단과 치료에 도움을 줄 수 있길 바란다.
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Affiliation(s)
- Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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Roebuck DJ, Murray C, McLaren CA. Imaging of Airway Obstruction in Children. Front Pediatr 2020; 8:579032. [PMID: 33262961 PMCID: PMC7686033 DOI: 10.3389/fped.2020.579032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
Various imaging techniques may be used to diagnose airway obstruction in children. Digital radiography, computed tomography and magnetic resonance imaging are the most important modalities, but the choice of technique will depend on the level and nature of suspected obstruction, as well as patient-specific factors such as age and ability to cooperate. This review examines the forms of airway obstruction that are commonly encountered in childhood.
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Affiliation(s)
- Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Pediatrics, Medical School, University of Western Australia, Crawley, WA, Australia
| | - Conor Murray
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia
| | - Clare A McLaren
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia.,School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
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21
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Lateral airways X-ray with a history of choking. J Paediatr Child Health 2019; 55:1509-1510. [PMID: 31846147 DOI: 10.1111/jpc.2_14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 12/01/2022]
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22
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Wang MX, Baxi A, Rajderkar D. Pictorial review of non-traumatic thoracic emergencies in the pediatric population. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Two cases of unusual airway pathology, in which a careful history contributed to a successful diagnosis. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541513 PMCID: PMC8424655 DOI: 10.7196/ajtccm.2018.v24i4.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/08/2022] Open
Abstract
Lower airway obstruction commonly presents with wheezing but is not always caused by asthma. Considering the case history and course of illness is of utmost importance in determining the cause of wheezing. We present two cases admitted to the paediatric intensive care unit, in which a double aortic arch was found to be the cause of wheezing. The cases illustrate the importance of a systematic approach when investigating a patient with persistent wheeze, especially when there is a poor response to conventional therapy.
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24
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Barnard BW, Du Plessis AM, Goussard P, Pitcher RD. Infantile intrathoracic large airway obstruction in a setting with a high prevalence of tuberculosis/HIV. Paediatr Int Child Health 2018; 38:106-112. [PMID: 29355460 DOI: 10.1080/20469047.2017.1422883] [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] [Indexed: 10/18/2022]
Abstract
Background There has been no detailed analysis of the cause of intrathoracic large airway obstruction in infants in a resource-limited environment with a high prevalence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV). Aim To define the aetiology and severity of intrathoracic large airway obstruction in infants in a tertiary South African hospital with a high prevalence of PTB and HIV. Methods A retrospective study of infants was conducted with computerised tomography (CT) evidence of intrathoracic large airway obstruction from 1 January 2011 to 31 May 2014. CT scans were evaluated for the cause, site and severity of airway narrowing, with severity stratified as 'mild' (<50%), 'moderate' (51-75%) or 'severe' (>75%). Results Forty-four patients (28 males, 64%; median age 145 days, range 5-331), and 79 sites of attenuation were included. Vascular (22/44, 50%) and nodal (18/44, 41%) compressions accounted for over 90% of cases. Thirty-five patients (79.5%) had at least one site of moderate/severe attenuation, and 26 (59%) had multiple such sites. Adenopathy was the commonest cause of moderate/severe compression (18/35, 51%). All cases of nodal compression were of tuberculous origin. HIV-serology was recorded in 32 patients (73%), one of whom, with vascular compression, was HIV-infected. Half of the patients (11/22, 50%) with vascular compression had congenital abnormalities, most commonly cardiac anomalies (7/22, 32%). There were no synchronous vascular and nodal compressions. Conclusion Infantile intrathoracic large airway obstruction where there is a high prevalence of PTB and HIV is characterised by its extrinsic aetiology, severity and multicentricity, with more than half of all moderate/severe obstructions being caused by tuberculous adenopathy.
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Affiliation(s)
- Benjamin Wybrand Barnard
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Anne-Marie Du Plessis
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Pierre Goussard
- b Division of Pulmonology, Department of Paediatrics, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Richard Denys Pitcher
- a Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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25
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Wu S, Zhuo L, Qiu X, Ding Z, Yang M, Pan M, Liu Q. Unexpected custodial death due to acute epiglottitis: A rare autopsy case report. Medicine (Baltimore) 2018; 97:e9941. [PMID: 29443781 PMCID: PMC5839830 DOI: 10.1097/md.0000000000009941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute epiglottitis is a potentially life-threaten disease, which makes it more challenging to save the life for doctors. Unexpected deaths in custody are a primary cause of concern for the forensic community and doctor worldwide. PATIENT CONCERNS We present a case of a 44-year-old male detainee who was clinically suspected of dying of acute epiglottitis. The man experienced failure of resuscitation and died after admitted to a hospital. DIAGNOSES The autopsy, toxicological testing, the test of immunoglobulin E and bacterial culture suggested the patient died of acute epiglottitis. INTERVENTIONS The bacterial culture was performed to imprecisely identify the cause of death. OUTCOMES The bacterial culture of the patient's heart blood and nasal and throat swabs showed the presence of the pathogenic microorganism Haemophilus influenza type B. LESSONS We aim to provide a reference to the medical and forensic community and remind the local law enforcement agencies on the problems present within the correctional healthcare system through this case report. Additionally, we also aim to increase the current knowledge and understanding on custodial deaths caused by natural diseases.
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Affiliation(s)
- Shifan Wu
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan Division of Forensic Science, Fujian Provincial Department of Public Security, Fuzhou Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PRC, Shanghai, P.R. China
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Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children. Radiol Clin North Am 2017; 55:845-867. [DOI: 10.1016/j.rcl.2017.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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Abstract
Cough and fever in infants and children are frequent but nonspecific symptoms. Several usual differential diagnoses are under consideration and imaging is often necessary to help arrive at an accurate diagnosis and ensure proper management. A broad spectrum of underlying disorders may be present. Radiologists must remain cognizant of the potential for immune dysfunction and underlying structural abnormalities. A clear understanding of up-to-date imaging evaluation recommendations and characteristic imaging features can assist radiologists and clinicians in arriving at the most accurate diagnosis in a timely manner and help ensure proper management and necessary follow-up imaging assessment.
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Stagnaro N, Rizzo F, Torre M, Cittadini G, Magnano G. Multimodality imaging of pediatric airways disease: indication and technique. Radiol Med 2017; 122:419-429. [PMID: 28224400 DOI: 10.1007/s11547-017-0737-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
Abstract
Congenital and acquired airway anomalies represent a relatively common albeit diagnostic and therapeutic challenge, even for the most skilled operators in dedicated centers. Airway malformations encompass a wide spectrum of pathologies involving the larynx, trachea and bronchi, esophagus, mediastinal vessels. These developmental lesions are often isolated but the association of two or more anomalies is not infrequent. From the traditional chest X-ray to the newest applications of Optical Coherence Tomography, non- or mini-invasive diagnostic techniques represent useful tools to integrate invasive procedures. Comprehensive knowledge of the characteristics of each diagnostic test is mandatory for its useful application. The aim of our paper is to analyze the clinical indications for Imaging the Airway disease in pediatric population, and describe the diagnostic techniques. Only by a close interaction between all the operators involved in diagnosis and treatment of pediatric airway, as it happens in Multidisciplinary Airway Team, the non- or mini-invasive imaging is effective.
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Affiliation(s)
- Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Rizzo
- Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Torre
- Airway Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Abstract
ABSTRACT
Pediatric neck masses comprise a wide spectrum of entities, benign and malignant. The role of imaging is to characterize these lesions, in order to better determine which can be expectantly managed and which require immediate intervention. An important consideration in the pediatric population is ionizing radiation; while X-ray and CT can be useful, radiation can have harmful effects, particularly in children. In this article, we review imaging feature of common pediatric neck masses, with emphasis on radiation sparing modalities (ultrasound and MRI) when possible.
How to cite this article
Sajedi P, Shet N. Imaging of Pediatric Neck Masses. Int J Head Neck Surg 2016;7(2):89-96.
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