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Endotracheal foreign bodies: Difficulties in diagnosis
ABSTRACTS
413
was excised. In a 5- and a 13-yr-old child, a malignant adenoma and a follicular carcinoma were identified and required total thyreoidectomy and subtotal resection of the goiter with removal of the secondaries, respectively. Both patients have been free of disease for 15 and 4 yr.--Andrew Pintbr A Familial Pattern of Thyroglossal Duct Cysts. J. S. M i l l i kan, P. Murr, E. E. Moore, and G. E. Moore. J A M A 244:1714, (October), 1980.
The authors report a case of a thyroglossal duct cyst in a healthy 1-yr-old girl. Family history revealed that a sibling had had the same lesion, also a maternal grandmother, a maternal great-grandmother, a maternal great-aunt, and a maternal cousin. One of the affected relatives also had carcinoma in the thyroglossal duct cyst and another had hypothyroidism. No previous cases of familial predisposition to thyroglossal duct cysts has been reported.--David L. Collins THORAX Endotracheal Foreign Bodies: Difficulties in Diagnosis. J. D.
Blumhagen, R. L. Wesenberg, J. G. Brooks, and E. K. Cotton. Clin Pediatr 19:480-484, (July), 1980.
Four patients with nut or seed tracheobronchial foreign bodies illustrate some of the pitfalls in the diagnosis of endotracheal foreign bodies. All of the children had normal radiographs initially that led to delay in bronchoscopic removal of the foreign bodies. Removal of foreign bodies of the bronchi by isoproterenol inhalation and postural drainage, initially reported to be 80% successful, has been found to be successful in only 25% of reported cases. The authors recommend a series of radiographic examinations prior to bronchoscopy but seem to urge bronchoscopy as a diagnostic aid in those patients with normal radiographs in the appropriate clinical setting.--Randall W. Powell Foreign Body Aspiration of Grass Inflorescences as a Cause of Hemoptysis. B. C. Hilman, F. T. Kurzweg, W. W.
McCook, Jr., and A. E. L/los. Chest 78:306 309, (August), 1980.
Four boys, ages 7, 13, and 14 (2), presented with pneumonitis and 3 had experienced hemoptysis. Two patients underwent lobectomy in which barley grass inflorescences were found. One coughed up an intact inflorescence with an episode of hemoptysis while the last patient extruded an inflorescence through the chest wall. This type of inflorescence (seed head) has a rigid stem with rigid spikelets that allows only forward movement in the bronchi and prevents retrograde passage. Aspiration may result in the lodging type of presentation with obstructive problems or extrusive type with migration of the inflorescence through the lung, pleura and chest wall. After migration to distal bronchi, the inflorescence is usually unable to be detected at bronchoscopy. The clinical signs and radiographic patterns vary and diagnosis is often delayed. The occurrence of hemoptysis with a persistent pneumonitis should alert one to the possibility of a foreign body as the etiology.--Randall W. Powell
Bronchiectasis in Pediatric Patients Resulting From Aspirated Grass Inflorescences. D. L. Dudgeon, F. B. Parker, et
al. Arch Surg 115:979-983, (August), 1980.
Four patients were diagnosed and treated who had severe bronchiectasis and/or hemoptysis following aspiration of grass inflorescence (flowering head). Each underwent bronchoscopy, bronchography, and conservative pulmonary resection (segment of lobe). All remain asymptomatic on long-term follow-up. The aspiration of this type foreign body is characterized initially by mild respiratory signs and symptoms often leading to progressive debilitating pulmonary disease. A high index of suspicion and, therefore, early recognition by bronchoscopy should result in successful endoscopic removal in the majority of instances.--George A. Rowe Chylothorax. T. Oshio, C. Matsumura, A. K/r/no, et al.
J Jpn Soc Pediatr Surg 16:1089 1095, (October), 1980. A 2-mo-old male infant who developed chylothorax after transabdominal repair of congenital diaphragmatic hernia (left side) is reported. This was successfully treated by drainage of the chest cavity and administration of MCT milk.--H. Suzuki Idiopathic Pulmonary Hypertension Associated with Nodular Pulmonary Infiltrates and Portal Venous Thrombosis.
J. S. Bower, D. R. Dantzker, and B. Nay~or. Chest 78:111113, (July), 1980.
A 16-yr-old female, previously diagnosed as having idiopathic pulmonary hypertension and portal venous thrombosis, presented with increasing dyspnea. At age 13 she underwent a splenorenal shunt for bleeding varices. While undergoing evaluation she developed acute respiratory difficulties and died. An admission, chest radiograph revealed an enlarged pulmonary outflow tract, slight cardiomegaly, and diffuse nodular pulmonary infiltrates. At necropsy, multiple 1 3 mm nodules were present throughout the lungs and microscopically represented an exuberant fibroblastic reaction surrounding pulmonary vessels involved with arteritis. The authors feel this is the first report of the arteritic change in idiopathic pulmonary hypertension causing radiographic abnormalities of the pulmonary parenchyma.--Randall HI. Powell Sarcoidosis in Japanese and American Children. E. L.
Kendig, Jr., and J. Niitu. Chest 77:514 516, (April), 1980.
Forty-five Japanese and 40 American children ranging in age from 3 to 15 yr were diagnosed as having sarcoidosis. Three of the Japanese presented with ocular symptoms while 42 were asymptomatic and discovered by a yearly chest radiograph required of school-aged children. Thirty-five of the 40 American patients presented with symptoms, the most common being fatigability, malaise or lethargy, cough, fever or dyspnea, and weight loss with adenopathy. Hilar adenopathy occurred in 44 of 45 Japanese and all 40 American patients. No Japanese children developed skin lesions while 10 American children did. Liver or spleen enlargement occurred in 12 and 9 American patients, respectively, while no Japanese children exhibited this finding. Osseous lesions
413
was excised. In a 5- and a 13-yr-old child, a malignant adenoma and a follicular carcinoma were identified and required total thyreoidectomy and subtotal resection of the goiter with removal of the secondaries, respectively. Both patients have been free of disease for 15 and 4 yr.--Andrew Pintbr A Familial Pattern of Thyroglossal Duct Cysts. J. S. M i l l i kan, P. Murr, E. E. Moore, and G. E. Moore. J A M A 244:1714, (October), 1980.
The authors report a case of a thyroglossal duct cyst in a healthy 1-yr-old girl. Family history revealed that a sibling had had the same lesion, also a maternal grandmother, a maternal great-grandmother, a maternal great-aunt, and a maternal cousin. One of the affected relatives also had carcinoma in the thyroglossal duct cyst and another had hypothyroidism. No previous cases of familial predisposition to thyroglossal duct cysts has been reported.--David L. Collins THORAX Endotracheal Foreign Bodies: Difficulties in Diagnosis. J. D.
Blumhagen, R. L. Wesenberg, J. G. Brooks, and E. K. Cotton. Clin Pediatr 19:480-484, (July), 1980.
Four patients with nut or seed tracheobronchial foreign bodies illustrate some of the pitfalls in the diagnosis of endotracheal foreign bodies. All of the children had normal radiographs initially that led to delay in bronchoscopic removal of the foreign bodies. Removal of foreign bodies of the bronchi by isoproterenol inhalation and postural drainage, initially reported to be 80% successful, has been found to be successful in only 25% of reported cases. The authors recommend a series of radiographic examinations prior to bronchoscopy but seem to urge bronchoscopy as a diagnostic aid in those patients with normal radiographs in the appropriate clinical setting.--Randall W. Powell Foreign Body Aspiration of Grass Inflorescences as a Cause of Hemoptysis. B. C. Hilman, F. T. Kurzweg, W. W.
McCook, Jr., and A. E. L/los. Chest 78:306 309, (August), 1980.
Four boys, ages 7, 13, and 14 (2), presented with pneumonitis and 3 had experienced hemoptysis. Two patients underwent lobectomy in which barley grass inflorescences were found. One coughed up an intact inflorescence with an episode of hemoptysis while the last patient extruded an inflorescence through the chest wall. This type of inflorescence (seed head) has a rigid stem with rigid spikelets that allows only forward movement in the bronchi and prevents retrograde passage. Aspiration may result in the lodging type of presentation with obstructive problems or extrusive type with migration of the inflorescence through the lung, pleura and chest wall. After migration to distal bronchi, the inflorescence is usually unable to be detected at bronchoscopy. The clinical signs and radiographic patterns vary and diagnosis is often delayed. The occurrence of hemoptysis with a persistent pneumonitis should alert one to the possibility of a foreign body as the etiology.--Randall W. Powell
Bronchiectasis in Pediatric Patients Resulting From Aspirated Grass Inflorescences. D. L. Dudgeon, F. B. Parker, et
al. Arch Surg 115:979-983, (August), 1980.
Four patients were diagnosed and treated who had severe bronchiectasis and/or hemoptysis following aspiration of grass inflorescence (flowering head). Each underwent bronchoscopy, bronchography, and conservative pulmonary resection (segment of lobe). All remain asymptomatic on long-term follow-up. The aspiration of this type foreign body is characterized initially by mild respiratory signs and symptoms often leading to progressive debilitating pulmonary disease. A high index of suspicion and, therefore, early recognition by bronchoscopy should result in successful endoscopic removal in the majority of instances.--George A. Rowe Chylothorax. T. Oshio, C. Matsumura, A. K/r/no, et al.
J Jpn Soc Pediatr Surg 16:1089 1095, (October), 1980. A 2-mo-old male infant who developed chylothorax after transabdominal repair of congenital diaphragmatic hernia (left side) is reported. This was successfully treated by drainage of the chest cavity and administration of MCT milk.--H. Suzuki Idiopathic Pulmonary Hypertension Associated with Nodular Pulmonary Infiltrates and Portal Venous Thrombosis.
J. S. Bower, D. R. Dantzker, and B. Nay~or. Chest 78:111113, (July), 1980.
A 16-yr-old female, previously diagnosed as having idiopathic pulmonary hypertension and portal venous thrombosis, presented with increasing dyspnea. At age 13 she underwent a splenorenal shunt for bleeding varices. While undergoing evaluation she developed acute respiratory difficulties and died. An admission, chest radiograph revealed an enlarged pulmonary outflow tract, slight cardiomegaly, and diffuse nodular pulmonary infiltrates. At necropsy, multiple 1 3 mm nodules were present throughout the lungs and microscopically represented an exuberant fibroblastic reaction surrounding pulmonary vessels involved with arteritis. The authors feel this is the first report of the arteritic change in idiopathic pulmonary hypertension causing radiographic abnormalities of the pulmonary parenchyma.--Randall HI. Powell Sarcoidosis in Japanese and American Children. E. L.
Kendig, Jr., and J. Niitu. Chest 77:514 516, (April), 1980.
Forty-five Japanese and 40 American children ranging in age from 3 to 15 yr were diagnosed as having sarcoidosis. Three of the Japanese presented with ocular symptoms while 42 were asymptomatic and discovered by a yearly chest radiograph required of school-aged children. Thirty-five of the 40 American patients presented with symptoms, the most common being fatigability, malaise or lethargy, cough, fever or dyspnea, and weight loss with adenopathy. Hilar adenopathy occurred in 44 of 45 Japanese and all 40 American patients. No Japanese children developed skin lesions while 10 American children did. Liver or spleen enlargement occurred in 12 and 9 American patients, respectively, while no Japanese children exhibited this finding. Osseous lesions