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Published on: August 7, 2017
Inflammatory endobronchial polyps in childhood: clinical spectrum and possible link to mechanical ventilation
D McShane1, A G Nicholson, P Goldstraw
1Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, UK. donna.mcshane@ic.ac.uk
Insights
Pediatric airway inflammatory polyps are rare but linked to neonatal mechanical ventilation. Polypectomy is an effective treatment, often resolving symptoms like lobar collapse.
Area of Science:
- Pediatric Pulmonology
- Respiratory Pathology
Background:
- Inflammatory polyps are distinct nonneoplastic endobronchial lesions in adults, typically linked to chronic inflammation.
- Their occurrence in children is rare, with unclear causes.
Observation:
- Retrospective review of four pediatric cases from Royal Brompton Hospital.
- Three of four patients had a history of neonatal mechanical ventilation, with polyps in the right proximal airways.
- Presentations included lobar collapse (3 patients) and hyperinflation (1 patient).
Findings:
- Inflammatory endobronchial polyps in children may be associated with prior mechanical ventilation, suggesting airway trauma as a cause.
- Neonatal airway size might also contribute to polyp development and presentation.
Implications:
- Highlights a potential link between neonatal mechanical ventilation and endobronchial polyp formation.
- Suggests polypectomy as a successful treatment modality for pediatric inflammatory polyps.
- Informs understanding of rare pediatric airway lesions and their etiology.
Abstract:
Inflammatory polyps of the airways are now regarded as histopathologically distinct nonneoplastic endobronchial lesions, which in adults are associated with a variety of chronic inflammatory insults. However, their clinical presentation in the pediatric population is extremely rare, with the etiology of such polyps poorly defined. The clinical and histopathological data from four pediatric patients, identified in the histopathology files of the Royal Brompton Hospital, were retrospectively reviewed. Three out of 4 patients had a history of mechanical ventilation in the neonatal period. In these 3 patients, the polyps were all situated in the proximal airways on the right side. These 3 patients presented at 6 weeks, 7 weeks, and 2 years, respectively, and were successfully treated by polypectomy at rigid bronchoscopy, with subsequent return to normality. One patient, presenting at 12 years of age without history of iatrogenic intervention, underwent a left lower lobectomy for a polyp sited in a segmental bronchus. Presentation in 3 of the 4 patients was with lobar collapse. The fourth patient presented with hyperinflation. We conclude that inflammatory endobronchial polyps may be associated with a history of mechanical ventilation in the neonatal period, polyp formation perhaps being secondary to airway trauma. The small caliber of the main airways in neonates may also be a contributory factor in presentation.
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