DOCSLIB.ORG

Radiographic Patterns of Acute Chest Syndrome Long-Term Lung Function

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Radiographic Patterns of Acute Chest Syndrome Long-Term Lung Function PostScript CORRESPONDENCE paediatric cohort of patients with postin- mean increase per year during childhood Thorax: first published as 10.1136/thoraxjnl-2015-207088 on 13 April 2015. Downloaded from fectious bronchiolitis obliterans (BO). The as done in the abstract. authors concluded that pulmonary func- Radiographic patterns of tion remained severely impaired, showing Martin Rosewich, Jonas Eckrich, Stefan Zielen acute chest syndrome an obstructive pattern with air trapping Department of Allergy, Pulmonology and Cystic Fibrosis, ’ that slowly improved during childhood. Children s Hospital, Goethe-University, Frankfurt am Main, Germany Dear editor, In addition, they showed that nine (19%) We read with great interest the year in patients developed thoracic deformity and Correspondence to Dr Martin Rosewich, Department of Allergy, Pulmonology and Cystic Fibrosis, Children’s review 2014 by Andy Bush and Ian seven (15.2%) bronchiectasis. On the first 1 Hospital, Goethe-University, Theodor-Stern-Kai 7, Pavord on paediatric and adult clinical view, contrary to their findings, the FVC 60590 Frankfurt am Main, Germany; Martin. 2 studies. While discussing our paper, the and FEV1 increased by a mean of 11%/ [email protected] reviewer seems to have misinterpreted our year (95% CI 9.3% to 12.6%; p<0.0001) results when saying that consolidation is Contributors All authors did substantial contributions and 9%/year (95% CI 7.7% to 10.2%; to the conception of the work, took part in the more severe in the apex of adult sickle p<0.0001) during childhood. This is acquisition, analysis and interpretation of data. They cell disease patients with acute chest syn- quite difficult to understand since the drafted the work and did the final approval. The drome. In fact, CT and bedside chest radi- authors did report the increase in lung authors are accountable for all aspects of the work. ography showed that lung parenchyma volume in per cent only, but not in litre Funding Starke Lunge Foundation. was increasingly consolidated from apex (L). Still, their findings are in good Competing interests None declared. 2 to base. This distribution is in accordance accordance with our findings in BO. 34 Ethics approval Ethics Committee of with previous studies, but may vary We have recently characterised a cohort Goethe-University clinic. with age, with young children having of 16 patients with BO aged median 13.3± Provenance and peer review Not commissioned; more upper and middle lobe disease, con- 4.6 years and measured their lung func- internally peer reviewed. 3 trarily to adult patients. tion prospectively over 24 months by 48 plethysmographies (three measurements Armand Mekontso Dessap in each patient). Of these patients, nine Correspondence to Professor Armand Mekontso were in the period of growth. Dessap, AP-HP, Hôpitaux Universitaires Henri Mondor, fi DHU A-TVB, Service de Réanimation Médicale; UPEC, Our data con rmed that BO patients To cite Rosewich M, Eckrich J, Zielen S. Thorax Faculté de Médecine, Groupe de recherche clinique had significantly lower lung function 2015;70:792. CARMAS; 51 Av Mal deLattre de Tassigny, Créteil, (FVC, FEV1, FEV1/VC, MEF25 and Received 3 March 2015 Cedex 94 010, France; [email protected] increased residual volume (RV) and RV/ Accepted 9 April 2015 TLC (total lung capacity) values) as age- Published Online First 28 April 2015 Competing interests None declared. matched controls. Provenance and peer review Not commissioned; As shown in table 1, lung function of internally peer reviewed. patients during growth period remained stable when expressed as predicted level http://thorax.bmj.com/ ▸ of normal. But there was a significant http://dx.doi.org/10.1136/thoraxjnl-2015-207112 increase in lung growth by a mean of Thorax 2015;70:792. FVC 0.3 L (14.1%) and FEV1 0.19 L To cite Mekontso Dessap A. Thorax 2015;70:792. doi:10.1136/thoraxjnl-2015-206998 (13.3%) in the first year and FVC 0.08 L Received 21 March 2015 (3.98%) and FEV1 0.03 L (2.09%) in the Accepted 25 March 2015 second year indicating that lung growth REFERENCE Published Online First 13 April 2015 1 Colom AJ, Maffey A, Bournissen FG, et al. Pulmonary is clearly related to growth velocity. Thorax function of a paediatric cohort of patients with 2015;70:792. on September 23, 2021 by guest. Protected copyright. doi:10.1136/thoraxjnl-2015-207088 Therefore, to avoid misunderstanding, postinfectious bronchiolitis obliterans. A long term lung growth should not be expressed as follow-up. Thorax 2015;70:169–74. REFERENCES 1 Bush A, Pavord I. Year in review 2013: paediatric and adult clinical studies. Thorax 2015;69:309–11. 2 Mekontso Dessap A, Deux JF, Habibi A, et al. Lung imaging during acute chest syndrome in sickle cell disease: computed tomography patterns and diagnostic accuracy of bedside chest radiograph. Table 1 Lung function of growing patients with BO (n=9) Thorax – 2014;69:144 51. Initial Follow-up Follow-up Delta et al 3 Vichinsky EP, Styles LA, Colangelo LH, . Acute presentation 12 month 24 months change chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Age (years) 10.9 11.9 12.9 2 Cell Disease. Blood 1997;89:1787–92. Length 143.3 148.6 153.0 9.7 4 Mekontso Dessap A, Deux JF, Abidi N, et al. Pulmonary artery thrombosis during acute chest syndrome in sickle cell FVC (%) 77.61 81.38 79.69 2.08 disease. AmJRespirCritCareMed2011;184:1022–9. FVC (L) 2.01 2.31 2.39 0.38 FEV1 (%) 65.86 69.21 65.19 −0.67 Long-term lung function in FEV1 (L) 1.43 1.62 1.65 0.22 − postinfectious bronchiolitis FEV1/VC 70.17 70.78 67.80 2.37 RV (%) 162.98 220.31 173.71 10.72 obliterans RV/TLC 42.07 46.26 40.42 −1.65 We read with great interest the paper by Data are shown as mean. Colom et al1 on pulmonary function of a BO, bronchiolitis obliterans; RV, residual volume; TLC, total lung capacity; VC, vital capacity. 792 Thorax August 2015 Vol 70 No 8.
Load more

Recommended publications
  • Acute Chest Syndrome in Sickle Cell Disease Care Guideline
    Acute Chest Syndrome in Sickle Cell Disease Care Guideline Inclusion Criteria: · Children with sickle cell disease Recommendations/ · New pulmonary infiltrate on CXR, involving at least one Considerations complete lung segment, excluding atelectasis Predictors: · Pain crisis involving chest, shoulders Assessment and back · Admit to 5S or PICU · Post anesthesia complication · NPO · Respiratory Infections · History and physical with focus on pulmonary exam · On narcotics · Vitals, accurate height and weight · Asthma exacerbation · Strict I/O; Daily Weight · O2 saturation · Baseline Hgb level may run low < · Diagnostics: 9gm/dl CBC with retic, CMP with LDH, STAT type and screen, Hgb electrophoresis · If suspected pulmonary embolism, · Consider VBG for significant respiratory distress obtain CT angiogram of chest · CXR 2 view · Blood culture if fever >38, elevated WBC · May need more than 1 exchange · VRP if URI symptoms transfusion if clinical findings not improving Interventions · After recovery from acute crisis, pt · Stat Hematology consult (if not admitted to Hematology service) should be started on hydroxyurea if · Pulmonary consult not already taking; optimize dose · Notify apheresis team as soon as possible during working hours if anticipated procedure · History of more than 1 acute chest · Consult PICU for possible apheresis catheter placement crisis, consider chronic transfusion · Oxygen to keep O2 sat >=94% protocols to keep HgbS < 25% · Maintenance IV fluids · Antibiotics: ceftriaxone and azithromycin · If recurrent crises, consider
    [Show full text]
  • Acute Chest Syndrome
    CLINICAL PATHWAY PEDIATRIC ACUTE CHEST SYNDROME (ACS) Patients with sickle cell disease presenting with 1) a new pulmonary infiltrate on chest radiography AND 2) evidence of lower airway disease (e.g. cough, shortness of breath, retractions, rales, etc.) TABLE OF CONTENTS Algorithm- N/A Target Population Background | Definitions Initial Evaluation-N/A Clinical Management Diagnostic Tests Fluids | Nutrition Respiratory Therapy Table 1. Pediatric Asthma Score Treatment Table 2. Antimicrobial Medication Table 3. Pain Medication Table 4. Respiratory Medication Discharge Criteria Related Children’s Hospital Colorado Documents References Clinical Improvement Team TARGET POPULATION Inclusion Criteria • Patients with sickle cell disease (SS, SC, Sβ0 thalassemia, Sβ+ thalassemia) • Patients of all ages • Patients treated year round Exclusion Criteria • Patients without infiltrate on chest radiograph (e.g. asthma exacerbation) • Patients with severe pulmonary hypertension • Patients post bone marrow transplant • Well children with pneumonia Page 1 of 10 CLINICAL PATHWAY BACKGROUND | DEFINITIONS Acute chest syndrome (ACS) is the second most common reason for hospitalization in children with sickle cell disease and a leading cause of mortality. ACS is defined as a new pulmonary infiltrate on chest radiograph in the presence of evidence of lower respiratory tract disease (e.g. some combination of cough, shortness of breath, retractions, rales, etc.). In the majority of cases of ACS, an etiology is unable to be identified. The most common identified etiology of ACS is infection but it may also result from pulmonary vaso-occlusion, pulmonary infarction or fat embolism. The primary infectious agents implicated in ACS include: Chlamydia pneumoniae, Mycoplasma pneumoniae, Streptococcus pneumoniae, and viruses. Risk factors for ACS include vaso-occlusive pain crisis, anesthesia, and surgery.
    [Show full text]
  • Changes Seen on Computed Tomography of the Chest In
    Alves UD et al.Original / CT of the Article chest in sickle cell disease Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease* Alterações na tomografia computadorizada do tórax em pacientes adultos oligossintomáticos com doença falciforme Ursula David Alves1, Agnaldo José Lopes2, Maria Christina Paixão Maioli3, Andrea Ribeiro Soares3, Pedro Lopes de Melo4, Roberto Mogami5 Alves UD, Lopes AJ, Maioli MCP, Soares AR, Melo PL, Mogami R. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease. Radiol Bras. 2016 Jul/Ago;49(4):214–219. Abstract Objective: To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy. Materials and Methods: A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. Results: The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%.
    [Show full text]
  • Predictors of Impending Acute Chest Syndrome in Patients with Sickle Cell
    www.nature.com/scientificreports OPEN Predictors of impending acute chest syndrome in patients with sickle cell anaemia Salam Alkindi1,2*, Ikhlas Al-Busaidi1, Bushra Al-Salami1, Samir Raniga3, Anil Pathare 1 & Samir K. Ballas4 Acute chest syndrome (ACS) is a major complication of sickle cell anaemia (SCA) and a leading cause for hospital admissions and death. We aimed to study the spectrum of clinical and laboratory features of ACS and to assess the predisposing factors and predictors of severity. A retrospective case-control cohort was studied by retrieving patient information from electronic medical records after ethical approval. One hundred adolescents and adults with SCA and hospital admissions for ACS were identifed through the discharge summaries, along with 20 additional patients presenting with VOC, but without ACS (controls). Among the patients with ACS, fever (>38.5 °C), reduced oxygen saturation (<95) and asplenia signifcantly difered when compared to those of controls (p < 0.05, chi-squared test). The degree of severity was refected in the use of non-invasive ventilation (NIV), simple and exchange transfusions, and the presence of bilateral pleural efusions and multi-lobar atelectasis/consolidation, which were signifcantly higher in the cases with ACS than in the controls. Lower haemoglobin (Hb) and high WBC counts were also signifcantly diferent between the two groups (p < 0.05, Student’s t test). Using logistic regression, our study further demonstrated that asplenia, fever, and reduced O2 saturation, along with low Hb and leukocytosis, were important predictors for the development of ACS. Sickle cell anaemia (SCA) is an autosomal recessive disorder characterized by a point mutation in codon 6 of the beta globin chain, where glutamic acid is replaced by valine, resulting in the formation of HbS with varied clinical 1 manifestations .
    [Show full text]
  • Sickle Cell Pathway V2.1: Suspected Acute Chest Syndrome Table of Contents
    Sickle Cell Pathway v2.1: Suspected Acute Chest Syndrome Table of Contents Inclusion Criteria · New, non-atelactatic, pulmonary infiltrate in patient with a Stop and sickle cell hemoglobinopathy Review Exclusion Criteria · O2 need related to opiate use with no infiltrate on CXR Sickle Cell Care Suspected Acute Chest Syndrome Appendix Summary of Version Changes Approval & Citation Evidence Ratings For questions concerning this pathway, contact: Last Updated: October 2020 [email protected] Next Expected Review: October 2025 If you are a patient with questions contact your medical provider, Medical Disclaimer © 2020 Seattle Children’s Hospital, all rights reserved Sickle Cell Pathway v2.1: Suspected Acute Chest Syndrome Inclusion Criteria · New, non-atelactatic, pulmonary infiltrate in patient with a Stop and sickle cell hemoglobinopathy Review Exclusion Criteria · O2 need related to opiate use with no infiltrate on CXR Evaluations for Acute Chest · Physical Exam · CXR · O2 sats · Consider viral studies · Blood & Urine Cx · CBC, diff, retic and type and cross Admit if not already admitted Standard Conservative Therapy · Aggressive pain management · Incentive spirometry q 1 hrs while awake, 10 breaths every hour from 0800 to 2200 and with vital signs while awake from 2200 to 0800, as well as with every "as needed" IV bolus of pain medication, and prior to chest x-rays · Oxygen to maintain O2 saturation >93% · Ceftriaxone q 24 hours IV (Ciprofloxacin and Clindamycin if allergic to Ceftriaxone) ! · Azithromycin or other
    [Show full text]
  • Chapter 17 Dyspnea Sabina Braithwaite and Debra Perina
    Chapter 17 Dyspnea Sabina Braithwaite and Debra Perina ■ PERSPECTIVE Pathophysiology Dyspnea is the term applied to the sensation of breathlessness The actual mechanisms responsible for dyspnea are unknown. and the patient’s reaction to that sensation. It is an uncomfort- Normal breathing is controlled both centrally by the respira- able awareness of breathing difficulties that in the extreme tory control center in the medulla oblongata, as well as periph- manifests as “air hunger.” Dyspnea is often ill defined by erally by chemoreceptors located near the carotid bodies, and patients, who may describe the feeling as shortness of breath, mechanoreceptors in the diaphragm and skeletal muscles.3 chest tightness, or difficulty breathing. Dyspnea results Any imbalance between these sites is perceived as dyspnea. from a variety of conditions, ranging from nonurgent to life- This imbalance generally results from ventilatory demand threatening. Neither the clinical severity nor the patient’s per- being greater than capacity.4 ception correlates well with the seriousness of underlying The perception and sensation of dyspnea are believed to pathology and may be affected by emotions, behavioral and occur by one or more of the following mechanisms: increased cultural influences, and external stimuli.1,2 work of breathing, such as the increased lung resistance or The following terms may be used in the assessment of the decreased compliance that occurs with asthma or chronic dyspneic patient: obstructive pulmonary disease (COPD), or increased respira- tory drive, such as results from severe hypoxemia, acidosis, or Tachypnea: A respiratory rate greater than normal. Normal rates centrally acting stimuli (toxins, central nervous system events).
    [Show full text]
  • Medicare Approved Six Minute Walk Diagnosis Codes
    MEDICARE APPROVED DIAGNOSIS CODES FOR SIX MINUTE WALK TESTING ICD-10 Codes that Support Medical Necessity Group 1 Codes: ICD-10 CODE DESCRIPTION B44.81 Allergic bronchopulmonary aspergillosis C33 Malignant neoplasm of trachea C34.00 Malignant neoplasm of unspecified main bronchus C34.01 Malignant neoplasm of right main bronchus C34.02 Malignant neoplasm of left main bronchus C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.12 Malignant neoplasm of upper lobe, left bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung C34.32 Malignant neoplasm of lower lobe, left bronchus or lung C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung C34.91 Malignant neoplasm of unspecified part of right bronchus or lung C34.92 Malignant neoplasm of unspecified part of left bronchus or lung C78.00 Secondary malignant neoplasm of unspecified lung C78.01 Secondary malignant neoplasm of right lung C78.02 Secondary malignant neoplasm of left lung C78.30 Secondary malignant neoplasm of unspecified respiratory organ C78.39 Secondary malignant neoplasm of other respiratory organs
    [Show full text]
  • Plastic Bronchitis and the Role of Bronchoscopy in the Acute Chest Syndrome of Sickle Cell Disease*
    bronchoscopy Plastic Bronchitis and the Role of Bronchoscopy in the Acute Chest Syndrome of Sickle Cell Disease* Chuanpit Moser, MD; Eliezer Nussbaum, MD, FCCP; and Dan M. Cooper, MD Study objectives: To review the prevalence, clinical features, and role of bronchoscopy in patients with plastic bronchitis during the acute chest syndrome (ACS) of sickle cell disease (SCD). Design: Eight-year review of clinical experience. Setting: Tertiary referral children’s hospital. Patients: Twenty-six pediatric inpatients with 29 ACS episodes requiring diagnostic bronchos- copy. Results: Of the pediatric inpatients with ACS who underwent bronchoscopy, plastic bronchitis was diagnosed in 21 of 29 episodes (72%). There was no difference in clinical features between the patients with and without plastic bronchitis. Bronchoscopy was an essential diagnostic tool, but its therapeutic benefits were doubtful. Conclusions: This is the first report of the prevalence of plastic bronchitis in patients with ACS of SCD. In our patient population, this condition was found to be common. The role of diagnostic bronchoscopy is essential. A large series, multicenter study is required to determine whether bronchoscopy and BAL are therapeutically beneficial when added to currently practiced supportive care. (CHEST 2001; 120:608–613) Key words: acute chest syndrome; bronchial cast; bronchoscopy; plastic bronchitis; pneumonia; sickle cell Abbreviations: ACS ϭ acute chest syndrome; SCD ϭ sickle cell disease he acute chest syndrome (ACS) of sickle cell SCD center, (2) compare clinical features of the T disease (SCD) is characterized by sudden-onset group with plastic bronchitis and the group without fever, cough, chest pain, and pulmonary opacity on plastic bronchitis, and (3) explore the role of bron- radiographic examination.
    [Show full text]
  • A Protocol for a Systematic Literature Review: Comparing the Impact Of
    Bishop-Williams et al. Systematic Reviews (2017) 6:19 DOI 10.1186/s13643-016-0399-x PROTOCOL Open Access A protocol for a systematic literature review: comparing the impact of seasonal and meteorological parameters on acute respiratory infections in Indigenous and non-Indigenous peoples Katherine E. Bishop-Williams1*, Jan M. Sargeant1,2, Lea Berrang-Ford3, Victoria L. Edge1, Ashlee Cunsolo4 and Sherilee L. Harper1 Abstract Background: Acute respiratory infections (ARI) are a leading cause of morbidity and mortality globally, and are often linked to seasonal and/or meteorological conditions. Globally, Indigenous peoples may experience a different burden of ARI compared to non-Indigenous peoples. This protocol outlines our process for conducting a systematic review to investigate whether associations between ARI and seasonal or meteorological parameters differ between Indigenous and non-Indigenous groups residing in the same geographical region. Methodology: AsearchstringwillbeusedtosearchPubMed®, CAB Abstracts/CAB Direct©, and Science Citation Index® aggregator databases. Articles will be screened using inclusion/exclusion criteria applied first at the title and abstract level, and then at the full article level by two independent reviewers. Articles maintained after full article screening will undergo risk of bias assessment and data will be extracted. Heterogeneity tests, meta-analysis, and forest and funnel plots will be used to synthesize the results of eligible studies. Discussion and registration: This protocol paper describes our systematic review methods to identify and analyze relevant ARI, season, and meteorological literature with robust reporting. The results are intended to improve our understanding of potential associations between seasonal and meteorological parameters and ARI and, if identified, whether this association varies by place, population, or other characteristics.
    [Show full text]
  • Chest Pain in Children: It's Not All Heart • None
    6/18/2019 Disclosures Chest Pain in Children: It's Not All Heart • none • Cathy S. Woodward, DNP, RN, PNP-AC • Professor of Pediatrics • UT Health -San Antonio Objectives Chest Pain •List the most common causes of benign chest pain in children. •Discuss the differential for children presenting with acute chest pain. •Describe the must-not-miss assessments in children with serious chest pain. Chest Pain Incidence of CP complaints •3700 kids evaluated for CP only 1% related to cardiac cause. •Musculoskeletal •Pulmonary •Gastrointestinal •Anxiety •Unknown cause 1 6/18/2019 Musculoskeletal CP •Brief sharp chest pain •Worse with deep breathing and movement •History of trauma, fall, new exercise, cough Musculoskeletal Causes of CP Slipping Rib Syndrome •31% of children who see cardiologists •Described in 1919 •Connective, bony and muscular tissue •Hypermobility of ant ends of ribs 8-10 •Precordial catch – short duration, unclear •Precipitating cause – cough, exercise, etiology trauma •Costochondritis •Pain acute and is reproducible •Trauma •Hooking maneuver • Slipping rib syndrome Pulmonary Causes of CP Pneumothorax •Chest Pain with •Asthma SOB •Pneumonia/Pleuritis •Trauma or •Chronic cough spontaneous •Pneumothorax •No breath •Acute Chest Syndrome sounds on affected side 2 6/18/2019 Acute Chest Syndrome Gastrointestinal Causes of CP •Major cause of morbidity and mortality for •Esophageal reflux – burning pain, center of children with Sickle Cell Disease – vaso chest, pain increased or decreased by certain occlusive crisis foods and body position
    [Show full text]
  • Diagnosis, Risk Stratification, and Management of Pulmonary Hypertension of Sickle Cell Disease
    Diagnosis, Risk Stratification, and Management of Pulmonary Hypertension of Sickle Cell Disease Online Supplement Elizabeth S. Klings*1, 15, Roberto F. Machado*2, Robyn J. Barst3+, Claudia R. Morris4, Kamal K. Mubarak5, Victor R. Gordeuk6, Gregory J. Kato7, Kenneth I. Ataga8, J. Simon Gibbs9, Oswaldo Castro6, Erika B. Rosenzweig3, Namita Sood10, Lewis Hsu11, Kevin C.Wilson1,12,15, Marilyn J. Telen13, Laura M. DeCastro13, Lakshmanan Krishnamurti14, Martin H. Steinberg15, David B. Badesch16, Mark T. Gladwin17 1The Pulmonary Center, Boston University School of Medicine, 2Section of Pulmonary, Critical Care Medicine, Sleep and Allergy, University of Illinois Chicago, 3Department of Pediatrics and Medicine, Columbia University, 4Department of Pediatrics, Division of Pediatric Emergency Medicine, and the Emory Children’s Center for Developmental Lung Biology, Emory University School of Medicine, 5Division of Pulmonary and Critical Care, University of Florida, 6Center for Sickle Cell Disease, Howard University, 7Hematology Branch, National Heart, Lung and Blood Institute, 8Division of Hematology/Oncology, University of North Carolina, 9National Heart & Lung Institute, Imperial College London, 10Division of Pulmonary and Critical Care, Ohio State University, 11Division of Pediatric Hematology-Oncology, Children’s Hospital of the University of Illinois, 12 UpToDate, Waltham, MA, 13Division of Hematology, Duke University, 14Division of Pediatric Hematology, Children's Hospital of Pittsburgh, 15Department of Medicine, Boston University School of
    [Show full text]
  • An Adult Case of Plastic Bronchitis: a Rare and Multifactorial Disease
    19 Case Report An adult case of plastic bronchitis: a rare and multifactorial disease Matteo Coen1, Laurent Daniel2, Jacques Serratrice1 1Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland; 2Department of Pathology, La Timone University Hospital, Marseille, France Correspondence to: Matteo Coen, MD, PhD. Department of Internal Medicine, Geneva University Hospital, rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland. Email: [email protected]. Abstract: Plastic bronchitis is a rare and potentially fatal disease. Mainly a disease of the pediatric age, a few adult cases occurring after cardiac surgery have been described. We describe a case of a 41-year-old man suffering from several episodes of acute dyspnea and cough with expectoration of mucous plugs in the context of chronic allergic airway inflammation. We believe that the occurrence of plastic bronchitis in adulthood should not be overlooked particularly in patients with chronic inflammatory lung disease. Keywords: Mucous plug; bronchial cast; corticosteroids Submitted May 16, 2017. Accepted for publication Oct 13, 2017. doi: 10.21037/jtd.2017.12.02 View this article at: http://dx.doi.org/10.21037/jtd.2017.12.02 Introduction lower lobe with ventilation defects (Figure 1A,B). Flexible bronchoscopy showed bronchial obstruction (Figure 1C,D) Plastic bronchitis is a rare but serious disease. Mainly a from a dense plug that was removed en bloc (Figure 1E). disease of the pediatric age, its occurrence in adulthood Histology revealed a cast of necrotic cells with florid should not be overlooked in particular in patients with eosinophilic infiltration (Figure 2). Gram, Periodic Acid chronic inflammatory disease and those undergone heart Schiff (PAS) and Grocott’s stains were negative, and surgery.
    [Show full text]