Successful treatment of cicatricial stenosis of the main, intermediate and upper lobe bronchi of the right lung complicated by total lung atelectasis in an infant: a clinical case

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: The authors present a rare clinical case of stenosis of the main, intermediate and upper lobe bronchi of the right lung complicated by total lung atelectasis in an infant. They discuss issues of complex disease diagnostics, analyze X-ray and bronchological images, assess outcomes after multidisciplinary approach in the treatment of a premature baby as well as analyze data of catamnestic observation.

CLINICAL CASE DESCRIPTION: Girl T., one of monochorionic diamniotic twins, was born at 27 week gestation in 2021 with weight at birth 825 grams, Apgar score 4/5. Since her birth, she had artificial lung ventilation due to her deep immaturity and developed severe respiratory distress syndrome. At the age of 19 days, total atelectasis of the right lung was diagnosed in the child as a result of stenosis formation in the main, intermediate and upper lobe bronchi which was confirmed by clinical and radiological findings. A probable etiology of acquired stenosis is consequences of prolonged intubation under insufficiently formed cartilaginous framework. Chlamydial infection, detected in the child, could also support inflammatory process in the bronchi. The child was examined with the following instruments: radiography, multispiral computed tomography-angiography of the thoracic cavity, bronchofibroscopy, echocardiography. Laboratory tests: polymerase chain reaction of blood and sputum for herpes viruses type 1–6, mycoplasma, ureaplasma, Chlamydia pneumonia; blood enzyme immunoassays — antibodies to viruses of Herpesviridae type 1–6, Chlamydia trachomatis. Conservative therapy provided only temporal improvement; atelectasis was relapsing. At the age of 5 months and 20 days, the child underwent bronchoplasty with resection of damaged areas of the bronchi. Further, age-related diameter of the bronchial lumen was maintained by the staged bougienage. Catamnestic observation lasted for 3 years. Late timing of surgical intervention is explained by severe problems in a deeply premature and immature child that required immediate treatment (intraventricular hemorrhages, hydrocephalus, retinopathy, etc.). Effective surgical treatment (bronchoplasty), active growth of lung tissue at the first year of life as well as reasonable rehabilitation allowed to obtain good long-term outcomes. By the age of 1 year 2 months, normalization of right lung airiness was achieved. Currently, there is a slight reduction in right lung volume. Multispiral computed tomography-angiography revealed a few cylindrical bronchoectases in the segmental and subsegmental bronchi of the upper and middle lobes of the right lung which do not have clinical equivalents yet. The child is under pulmonologist's observation and management.

CONCLUSION: A multidisciplinary approach to the treatment of complicated patient's state and high compensatory capabilities of neonatal and infantile periods have promoted the restoration of normal lung aeration and functioning after long-lasting lung atelectasis

Full Text

Restricted Access

About the authors

Aleksander Y. Razumovskiy

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: 1595105@mail.ru
ORCID iD: 0000-0002-9497-4070
SPIN-code: 3600-4701

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow; Moscow

Svetlana A. Karavaeva

North-Western State Medical University named after I.I. Mechnikov

Email: swetl.karawaewa2015@yandex.ru
ORCID iD: 0000-0001-5884-9128
SPIN-code: 4224-5532

MD, Dr. Sci. (Medicine), Professor

Россия, Saint Petersburg

Tatiana V. Patrikeeva

Children's City Multidisciplinary Clinical Specialized Center of High Medical Technologies

Author for correspondence.
Email: tv_omelchenko@mail.ru
ORCID iD: 0000-0002-5247-836X
SPIN-code: 3823-4340

MD, Cand. Sci. (Medicine)

Россия, Saint Petersburg

Yuri V. Levadnev

North-Western State Medical University named after I.I. Mechnikov; Children's City Multidisciplinary Clinical Specialized Center of High Medical Technologies

Email: yu-lev@yandex.ru
ORCID iD: 0000-0003-4087-9462
SPIN-code: 5639-6315

MD, Cand. Sci. (Medicine)

Россия, Saint Petersburg; Saint Petersburg

Nadezhda V. Kulikova

Filatov N.F. Children's City Hospital

Email: dr.kulikovan.v@gmail.com
ORCID iD: 0000-0003-0834-2630
SPIN-code: 4687-1558

MD, Cand. Sci. (Medicine)

Россия, Moscow

Natalya N. Petrova

Children's City Multidisciplinary Clinical Specialized Center of High Medical Technologies

Email: penany@yandex.ru
ORCID iD: 0009-0006-6571-7696

MD

Россия, Saint Petersburg

References

  1. Pavlenko VV. Main clinical syndromes in respiratory diseases: methodical manual. In: StudFiles [Internet]. Stavropol: Stavropol State Medical University; 2008 [cited 2024 Apr 23]. Available from: https://studfile.net/preview/2704889/ (In Russ.)
  2. Weerakkody Y, Bell D, Kabbani AL, et al. Lung atelectasis. In: Radiopaedia [Internet]. Radiopaedia.org; 2005–2024 [cited 2023 Sep 09]. Available from: https://radiopaedia.org/articles/lung-atelectasis
  3. Zykova NV. Atelectasis of the lung. In: Beauty and Medicine [Internet]. Beauty and Medicine; 2024 [cited 2024 Apr 23]. Available from: http://krasotaimedicina.ru/ (In Russ.)
  4. Atelectasis. In: The National Heart, Lung, and Blood Institute [Internet]. Bethesda: NHLBI; 2024 [cited 2024 Apr 23]. Available from: https://web.archive.org/web/20190330163255/https://www.nhlbi.nih.gov/health-topics/atelectasis
  5. Peroni DG. Atelectasis: Mechanisms, diagnosis and management. Paediatr Respir Rev. 2000;1(3):274–278. doi: 10.1053/prrv.2000.0059
  6. Woodring JH. Types and mechanisms of pulmonary atelectasis. J Thorac Imaging. 1996;11(2):92–108. doi: 10.1097/00005382-199621000-00002
  7. Hansell DM, Bankier AA, MacMahon H, et al. Society: Glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722. doi: 10.1148/radiol.2462070712
  8. Madappa T. Atelectasis differential diagnoses. In: Medscape [Internet]. WebMD LLC; 1994–2024 [cited 2020 Oct 22]. Available from: https://emedicine.medscape.com/article/296468-differential?form=fpf

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1. Second day of life, сhest X-ray at admission.

Download (83KB)
3. Fig. 2. X-ray of the chest organs on the 17th day of life: positive dynamics.

Download (127KB)
4. Fig. 3. X-ray of the chest cavity on the 19th day of life: atelectasis of the lower lobe of the right lung.

Download (86KB)
5. Fig. 4. X-ray of the chest cavity on the 23rd day of life: total atelectasis of the right lung.

Download (73KB)
6. Fig. 5. X-ray of the chest organs at 1 month of life: positive dynamics.

Download (78KB)
7. Fig. 6. Multispiral computed tomography-angiography of the chest organs at 1.5 months of life: total atelectasis of the right lung (a — axial reconstruction, b — frontal reconstruction; c — sagittal reconstruction).

Download (154KB)
8. Fig. 7. Multispiral computed tomography-angiography of the chest organs at 4.5 months of life: total atelectasis of the right lung persists (a — axial reconstruction, b — frontal reconstruction; c — sagittal reconstruction).

Download (132KB)
9. Fig. 8. Chest X-ray on day 21 after surgery.

Download (93KB)
10. Fig. 9. Multispiral computed tomography-angiography of the thoracic cavity at the age of 1 year 2 months.

Download (81KB)
11. Fig. 10. Multispiral computed tomography-angiography of the thoracic cavity at the age of 1 year 2 months.

Download (71KB)
12. Fig. 11. Chest X-ray at the age of 2.5 years.

Download (116KB)

Copyright (c) 2024 Eco-Vector

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies