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Iatrogenic mediastinitis in bronchiolitis: Importance of avoiding pharyngeal aspiration
M Le Roch1, E Thebault2, S Beaudoin3
1Department of Pediatrics, CHU d'Ambroise-Paré, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne, France; UFR des sciences de la santé Simone Veil, University Versailles Saint-Quentin, 78000 Versailles, France.
Insights
Severe bronchiolitis in an infant led to pneumomediastinum and mediastinitis, likely from nasopharyngeal aspiration. This case highlights the need to reconsider routine aspiration practices in infants with bronchiolitis.
Area of Science:
- Pediatrics
- Medical Case Reports
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Nasopharyngeal aspiration is a frequently used procedure in managing respiratory distress.
- Complications of nasopharyngeal aspiration are rare, especially in non-premature infants.
Abstract:
An 11-month-old infant was hospitalized for his first episode of severe bronchiolitis, with pneumomediastinum on the chest x-ray performed in the emergency room before hospitalization. After a few days, the occurrence of a feverish torticollis motivated a CT scan, revealing mediastinitis. An iatrogenic perforation was objectified in the posterior wall of the esophagus, probably caused by nasopharyngeal aspiration. This exceptional case has never been reported before, except in premature infants. This encouraged us to report this case to change systematic aspiration practices and prefer nasal suctioning in healthy infants with bronchiolitis presenting to the emergency department.
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