Prevalence and characteristics of tracheal cobblestoning in children

Gerber, Andri; Bailey, Martin; Gysin, Claudine; Hoeve, Hans; Hammer, Jürg; Nicolaï, Thomas; Weiß, Markus

doi:10.1002/ppul.23142

Cited by 10 publications

(6 citation statements)

References 14 publications

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“…A previous study of preoperative bronchofibroscopy in children reported the incidence of tracheobronchial cobblestone mucosa to be 38.8%; the incidence in children under 3 years of age (43.5%) was significantly lower than that of children over 3 years of age (56.4%) and cobblestone mucosa was not detected in infants younger than 4 months of age. 3 The different incidences across different age groups are most likely to be associated with maturity of the immune system. We believe that this is the first report of this type of lesion in neonates.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous research has failed to confirm this assumption. 3,4 The pathogenesis of tracheobronchial cobblestone mucosa in utero is still unclear, partly because the fetal airway fills with lung fluid. It is difficult for stimulants to enter the airway unless hypoxia causes gasping breathing.…”

Section: Discussionmentioning

confidence: 99%

“…Tracheobronchial cobblestone mucosa does not usually cause respiratory symptoms in children. 3,4 In adults, edematous cobblestone mucosa has been reported as a manifestation of pulmonary complications in patients with inflammatory bowel disease; in such cases, diffuse edema mucosal protrusions lead to a narrow airway and respiratory distress. 7,8 This situation is similar to what we observed in our present case.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical ventilation was duly commenced. Laboratory tests were as follows: hemoglobin 16.5 g/dl, white blood cell count 16,490/mm 3 , platelet count 271,000/mm 3 , and C-reactive protein (CRP) 0.26mg/dl. Blood cultures were negative.…”

Section: Case Reportmentioning

confidence: 99%

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A neonate with tracheobronchial cobblestone mucosa presenting with acute severe hypercapnia

Liu¹,

Hu³

2019

Turk J Pediatr

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Here, we describe the case of a neonate suffering from respiratory distress complicated by pulmonary hemorrhage shortly after birth. The neonate experienced repeated dyspnea and acute severe hypercapnia (160-100 mmHg) that began on the 7th day after birth during invasive mechanical ventilation. Rescue high frequency oscillatory ventilation played a key role in maintaining gas exchange during these episodes. Subsequent bronchoscopy revealed tracheobronchial edematous mucosa with a cobblestone pattern, which we believe is the first report of this condition in neonates. Protrusion of the diffuse edematous mucosa led to airway stenosis and respiratory distress. Lesions of the tracheal mucosa should therefore be considered as one potential cause of neonatal respiratory distress.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

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A neonate with tracheobronchial cobblestone mucosa presenting with acute severe hypercapnia

Liu¹,

Hu³

2019

Turk J Pediatr

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“…A common finding in bronchoscopic airway evaluations is a “cobblestone” appearance of the airway, which is often attributed to GERD or aspiration. Dave et al reported a large retrospective study of healthy children who had rigid tracheoscopy at intubation for elective surgical procedures, and found evidence of cobblestoning in almost 40%, but with no association between prevalence of cobblestones and GERD, current or recent respiratory infection, or concomitant enlarged tonsils.…”

Section: Diagnostic Testing/endoscopymentioning

confidence: 99%

Pediatric pulmonology year in review 2015: Part 3

et al. 2016

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Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection.Word count: 71 3

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Exposures and coexisting conditions in pediatric nodular tracheobronchitis

Grant,

Collins,

Zur

et al. 2024

Pediatric Pulmonology

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BackgroundThe aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy.MethodsWe conducted a single‐center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023.ResultsCommon coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%). Bronchoalveolar lavage (BAL) demonstrated cellular inflammation with elevated proportions of neutrophils in 63%, and lymphocytes in 24%. Among 88 patients in whom bacterial cultures were performed, 52% were positive, with Moraxella, Haemophilus, Streptococcal and Pseudomonas species predominating. Among 30 patients who underwent viral testing, 57% were positive, with rhinovirus (82%) and adenovirus (29%) predominating. Patients with neutrophilic inflammation were more likely to have a positive respiratory bacterial culture and/or viral polymerase chain reaction (p = 0.003, 0.005). Evaluation of the gastrointestinal tract included 79 patients with a history of esophagogastroduodenoscopy, 45 patients with a videofluoroscopic swallow study (VFSS), and 45 patients with multi‐channel intraluminal impedance and pH testing. The majority of VFSS were abnormal (60%) demonstrating either laryngeal penetration (33%) or intratracheal aspiration (27%). Median pH reflux and impedance proximal reflux indices were 3.8% and 0.5% respectively.ConclusionPotential contributing factors in the pathophysiology of nodular tracheobronchitis include bacterial and viral infections, GERD, dysphagia/aspiration, and EOE. When nodular tracheobronchitis is observed during bronchoscopy, further evaluation to assess for these conditions should be considered.

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Prevalence and characteristics of tracheal cobblestoning in children

Abstract: The prevalence of tracheal cobblestones in otherwise healthy children is high and is not associated with GERD or respiratory infection. The gender and age related differences are novel interesting findings that require further investigations.

Cited by 10 publications

References 14 publications

A neonate with tracheobronchial cobblestone mucosa presenting with acute severe hypercapnia

A neonate with tracheobronchial cobblestone mucosa presenting with acute severe hypercapnia

Pediatric pulmonology year in review 2015: Part 3

Exposures and coexisting conditions in pediatric nodular tracheobronchitis

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