Intrinsic Endobronchial Obstructions in Children from Turkey: Evaluation of 2,555 Flexible Bronchoscopic Procedures

Abstract

Background: Endobronchial obstructions are rarely seen in children and are often misdiagnosed resulting in delay of definitive treatment. A variety of diseases can cause endobronchial obstructions in childhood, but data is limited as to the frequency, distribution and clinical characteristics of endobronchial obstructions diagnosed with flexible bronchoscopy (FB). Objective: To document endobronchial obstructions detected by FB. Methods: FB results from three pediatric pulmonology centers in Istanbul were evaluated. Results: A total of 2,555 children underwent an FB procedure during the study period. Endobronchial obstructions were detected in 10% (n = 256) of the patients. Among FB in patients who had endobronchial obstructions, the four most common indications for bronchoscopy were persistent infiltrations (30%, n = 72), persistent wheezing (28%, n = 70), chronic cough (26%, n = 66) and atelectasis (23%, n = 59). The most common endobronchial obstructions detected in the patients were aspirated foreign bodies (35.9%, n = 92), endobronchial tuberculosis (31.6%, n = 81), mucous plugs occluding airway (16.7%, n = 43) and granulation scars (6%, n = 16). Other pathologiesincluded hydatid cysts (n = 5), hemangiomas (n = 5), tumors (n = 5), submucosal nodules (n = 5) and polyps (n = 4). Endobronchial obstructions were most commonly located in the right bronchus (51%, n = 130) followed by the left bronchus (33%, n = 85), bilaterally (8%, n = 21) and trachea (8%, n = 20). Conclusions: Endobronchial obstructions can be caused by a number of different diseases which require various medical or surgical treatments. In the presence of clinical or radiological findings suggesting an endobronchial obstruction, FB should be performed promptly.

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia

“…The BAL is considered as a key exam in various conditions such as chronic interstitial lung diseases. FB also helps in the treatment of some pathologies such as a foreign body granuloma by cryotherapy, or pulmonary alveolar proteinosis (PAP) by a therapeutic BAL 3,4 .…”

“…FB and endoscopic sampling can confirm or decline several diagnoses but their contribution varies according to their indications, consisting mostly in bronchopulmonary chronic or recurrent symptoms or in searching an obstacle or an abnormal airway anatomy 4,[8][9][10] . In an Indian pediatric series on 529 FB, 284 (53.6%) were abnormal.…”

Broncoscopía flexible en niños con atelectasias persistentes. Serie de casos

“…7 La bronquitis obstructiva recurrente fue la principal comorbilidad asociada a la presencia de atelectasias persistentes con presencia de secreciones endobronquiales y formaciones de tapones mucosos, hallazgo que concuerda con los reportes de otros centros. [8][9][10] La BF fue un procedimiento efectivo, ya que se logró una utilidad terapéutica en el 87% de los casos (reexpansión completa en el 65,6% o parcial en el 21,8%). Estos hallazgos concuerdan con lo reportado por otros centros.…”

Paediatrics in Barcelona

“…In a retrospective study, KUT et al [157] evaluated endobronchial obstructions detected during 2555 flexible bronchoscopies. The most frequent obstructive lesions were aspirated FBs, followed by endobronchial tuberculosis, mucous plugs and granulation tissue.…”