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Published on: November 1, 2018
An Infant With Congenital Tracheal and Bronchial Stenosis Diagnosed by Chest Three-Dimensional Computed Tomography
Yuko Moriuchi1,2, Tatsuo Fuchigami1,2, Waka Mizukoshi3
1Department of Pediatrics, IMS Fujimi General Hospital, Saitama, JPN.
Insights
Congenital tracheal and bronchial stenosis can cause persistent wheezing in infants. Early diagnosis using chest 3D-CT and virtual bronchoscopic navigation aids in identifying these airway obstructions.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Diagnostic Technology
Background:
- Infants presenting with recurrent wheezing and pneumonia often require thorough investigation.
- Congenital airway anomalies can be challenging to diagnose, especially in early infancy.
- Standard treatments for wheezing may not resolve symptoms caused by structural airway issues.
Observation:
- A six-month-old infant experienced persistent wheezing despite treatment for pneumonia.
- Chest three-dimensional computed tomography (3D-CT) revealed significant tracheal and bronchial stenosis.
- Virtual bronchoscopic navigation provided a non-invasive airway visualization based on CT data.
Findings:
- Congenital tracheal and bronchial stenosis was confirmed as the cause of the infant's symptoms.
- 3D-CT imaging accurately depicted the stenotic segments of the airway.
- Virtual bronchoscopic navigation offered a complementary diagnostic tool to traditional bronchoscopy.
Implications:
- Congenital airway stenosis should be considered in infants with prolonged or unexplained wheezing.
- Chest 3D-CT combined with virtual bronchoscopic navigation can facilitate early diagnosis of airway stenosis.
- This imaging approach may be particularly valuable in settings where direct bronchoscopy is not readily available.
Abstract:
In this case report, we describe the case of an infant with repeated wheezing diagnosed relatively early with congenital tracheal and bronchial stenosis after evaluation by chest three-dimensional computed tomography (3D-CT). The patient was a six-month-old male infant with a one-month history of cough and wheezing. His symptoms worsened the day before admission, and he was admitted with pneumonia and wheezing. However, wheezing continued after treatment with intravenous steroids and inhalation of a short-acting β2-stimulant. 3D-CT of the chest revealed tracheal stenosis, right bronchial stenosis, and right tracheobronchial bronchus. The patient was finally diagnosed with congenital tracheal and bronchial stenosis via bronchoscopy. A virtual bronchoscopic navigation image of the tracheal lumen was created based on the CT images. Although virtual bronchoscopic navigation is more difficult for the dynamic evaluation and evaluation of mucosal lesions than bronchoscopy, it has the advantage of not directly invading the airway. Therefore, if a fixed stenotic lesion is suspected at a facility where bronchoscopy is difficult, evaluation using chest 3D-CT and virtual bronchoscopic navigation may be helpful for diagnosis. In conclusion, congenital tracheal/bronchial stenosis should be considered in patients with prolonged wheezing and recurrent airway infections, and evaluation by chest 3D-CT and virtual bronchoscopic navigation may be helpful for diagnosis.
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