Radiographic studies will reveal the presence of radiopaque objects and can also identify focal air trapping, especially on expiratory views. Thus, when foreign body aspiration is suspected, expiratory or lateral decubitus chest radiographs should be ordered. In addition, fluoroscopy may be helpful, especially in children who cannot perform expiratory views. If there is strong evidence (or history) of foreign body aspiration, the patient should undergo rigid bronchoscopy. Flexible bronchoscopy can be used to locate an aspirated foreign body and may be useful when the presentation is not straightforward, but foreign body removal is best performed via rigid bronchoscopy.
The best approach to preventing foreign body aspiration is to educate parents and caregivers. Before molar teeth have erupted, infants and children should not be given nuts, uncooked carrots, or other foods that may be easily broken into small pieces and aspirated. Sound parental judgment is required to determine at what age and stage of development small objects should be accessible to children.
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SEE CHAPTER 109.
SEE CHAPTER 61.
Endobronchial mass lesions are relatively uncommon in children. The most common lesion is granulation tissue, which usually results from local inflammation. Tuberculosis can cause endobronchial granulomas. Primary tumors of the lung are extremely rare in children. The most common airway malignancy is the nonsecreting carcinoid tumor. Endobronchial lesions that partially obstruct an airway present with wheezing or obstructive emphysema and occasionally with hemoptysis. If the lesion completely occludes the airway, then atelectasis may result. Radiographs and CT scans of the chest aid in making the diagnosis. Bronchoscopy is often used to confirm the diagnosis.
Congenital lobar overdistention (formerly referred to as congenital lobar emphysema) consists of overinflation of onelobe of a lung. This overdistention may cause severe respiratory distress in the neonatal period due to compression ofsurrounding normal lung tissue, but it can also be asymptomatic and remain undiagnosed for years. Radiographically,it may be mistaken for a pneumothorax. Lobectomy may berequired if respiratory distress is severe or progressive, but ifthe patient is asymptomatic, then surgical resection may notbe indicated.
Pulmonary hypoplasia, or a relative decrease in amount of alveoli, may be the result of a number of congenital insults, such as congenital diaphragmatic hernia (see Chapter 61) or unilateral congenital absence of a pulmonary artery. Alveolar growth occurs after birth predominantly up to 3 years, but has been documented up to 8 years.
Emphysema is a condition due to disruption or destruction of alveolar septa. In pediatrics, the term emphysema often refers to hyperinflation or to leakage of air into the pulmonary interstitial spaces (interstitial emphysema, which may be seen in mechanically ventilated premature infants) or the subcutaneous tissue (subcutaneous emphysema). Although emphysema is common in adults, it is rare in children. However, generalized or localized hyperinflation, which can be caused by airway obstruction from a variety of causes, is common. Emphysema is commonly observed in the disease α1-antitrypsin deficiency, but it rarely appears before the second decade of life.
Primary ciliary dyskinesia (PCD, immotile cilia syndrome)is an inherited disorder in which ultrastructural abnormalities in the cilia result in absent or disordered movement of the cilia. This disorder affects approximately 1 in 19,000persons. There are many reported abnormalities in ciliarystructure, but the most common are due to defects in the dynein arms, ultrastructural features that provide energy viaadenosine triphosphatase (ATPase), which is necessary forciliary motility.