Pediatric bronchiectasis
Introduction
Introduction to bronchiectasis in children A chronic suppurative disease in which the bronchial dilatation bronchus is caused by repeated infection, obstruction of secretions, or congenital developmental defects, resulting in wall destruction, deformation, and expansion. The lesion is generally irreversible and progresses slowly. About 50% of adult patients, the symptoms often arise from childhood, mainly characterized by frequent fever, cough, phlegm, and even hemoptysis. In recent years, due to the prevention and treatment of respiratory infections and the timely application of antibiotics, the incidence has been reduced. The symptoms are also lighter than in the past. basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: non-infectious Complications: lung abscess
Cause
Causes of bronchiectasis in children
(1) Causes of the disease
Bronchiectasis can be divided into two major categories: congenital and acquired:
Congenital bronchiectasis
Less common, due to bronchial cartilage development defects, found in infants; or due to tracheobronchial muscle and elastic fiber development defects caused by large tracheobronchomegaly (tracheobronchomegaly), found in older children.
2. Acquired bronchiectasis
Common in measles, whooping cough, bronchiolitis and severe pneumonia, especially adenovirus type 21, type 7 and type 3 are more common in severe pneumonia, asthma is also common, caused by such causes are mostly double Side diffuse bronchiectasis, if due to foreign body blockage, bronchial lymph node tuberculosis or tumor compression, and long-term existence of bronchial tuberculosis with atelectasis caused by bronchiectasis, mostly limited, bronchiectasis and some specific defense defects of the body Related to, mainly including humoral immunodeficiency, local immune defense defects and immune disorders, among which, most commonly seen in patients with humoral immunodeficiency, such as X-linked hypogammaglobulinemia, common variant immunodeficiency disease, IgG subclass defects are also One of the causes of bronchiectasis, local immune defense defects, patients with primary ciliary dyskinesia, due to poor ciliary movement, resulting in reduced mucociliary clearance, in addition, benign or malignant tumors, rib bone hyperplasia can also lead to bronchial expansion.
(two) pathogenesis
Infection and bronchial obstruction are two fundamental pathogenic factors, which promote each other. Due to bronchial obstruction, the secretion of stagnation in the cavity is stressed by the bronchial wall that is affected by inflammation and softened by injury. Expansion, at the same time, the infection causes severe cough, which increases the intrabronchial pressure and promotes bronchiectasis. In addition, lung consolidation or atelectasis persists for a long time, lung tissue fibrosis and scar contraction, resulting in bronchial traction, distortion And shifting is also a factor contributing to bronchiectasis.
Prevention
Pediatric bronchiectasis prevention
Children with pneumonia should be followed up carefully until complete recovery. Timely treatment of bronchial lymph node tuberculosis and early removal of bronchial foreign bodies are measures to prevent bronchiectasis. Prevention and treatment of acute and chronic respiratory infections such as measles, whooping cough, bronchial pneumonia and tuberculosis are of great significance in the prevention of bronchiectasis. Patients with bronchiectasis should actively prevent respiratory infections, adhere to body sputum excretion, and enhance the body's immune function to improve the body's disease resistance.
Complication
Pediatric bronchiectasis complications Complications, lung abscess, empyema
The atelectasis and dilated bronchial common infections recur, the degree of which is different, the lighter only has low fever and increased sputum, and severe cases of pneumonia and lung abscess. Bronchiectasis often causes pneumonia, lung abscess, lung gangrene, empyema, and pneumothorax due to concurrent pyogenic infection. When the lung tissue is extensively fibrotic and the pulmonary capillary bed is severely damaged, the pulmonary circulatory resistance may increase. , pulmonary hypertension, causing chronic pulmonary heart disease.
Symptom
Symptoms of bronchiectasis in children Common symptoms Persistent cough and thoracic deformity hemoptysis
Main symptoms
For coughing, phlegm, more common in the morning after getting up or changing position, the amount of sputum is more or less, thick pus, odor is not heavy, irregular fever is not uncommon, the sequelae of different degrees can be seen in the course of the disease, Anemia and malnutrition, patients are prone to infection, lower respiratory tract infections, often repeated pneumonia, and even complicated with lung abscess, often limited to the same lesion.
2. Chest signs
Similar to pneumonia, but disparity, sometimes auscultation has no gain, but most of them can be heard at the bottom of the lungs, the position is relatively fixed, if the ward is wide, the mediastinum and heart are often due to atelectasis or fibrotic lesions. Shifting on the disease side, the child's nutritional development is backward, the thoracic deformity, the clubbing, the appearance of the toe is different, the earliest one can occur in 1 to 2 months, and can disappear naturally after the surgical lobectomy, maxillary sinus More common inflammation, such as the continued development of the disease, liver enlargement and proteinuria, but also amyloidosis and pulmonary hypertrophic osteoarthritis.
Examine
Examination of bronchiectasis in children
The total number of white blood cells and neutrophils were in the normal range, and increased in secondary infections. There was no significant change in red blood cells and hemoglobin. Some of them were slightly anemia, and the blood sedimentation rate was slightly increased. There was no constant sputum examination. The bacteria found that several bacteria are common in clinical practice. These pathogens include hemolytic streptococcus, Streptococcus viridans, pneumococci, Klebsiella, Staphylococcus aureus, Haemophilus influenzae, Aerobacteria, etc. Sputum culture and susceptibility testing should be performed before treatment.
X-ray inspection
When mild, only the lung texture is aggravated. When the lesion is obvious, the double middle and lower lungs can be seen in the shape of a ring-shaped light-transparent shadow, which is curled or honeycomb-shaped, often accompanied by a segment of the lung or atelectasis and inflamed infiltration shadow. The heart and mediastinum can be seen to be displaced. X-rays can be seen in bronchiectasis and deformation.
2. Bronchography
It can be shown that the bronchus is columnar, fusiform or saclike, and the shape, location and extent of bronchiectasis should be clearly defined. Preoperative preparation should be done to prevent accidental asphyxia. Fasting should be done before surgery to avoid vomiting. To remove iodized oil from the stomach to avoid iodine poisoning.
3. CT examination
In recent years, high-resolution CT has replaced bronchography, which is safe, reliable, simple and easy to perform. Its sensitivity and specificity are the same as those of bronchography. It has become the main method for the diagnosis of bronchiectasis.
Diagnosis
Diagnosis and diagnosis of bronchiectasis in children
diagnosis
No obvious symptoms have been found in the early stage, and the diagnosis is difficult. In the stage of chronic infection, there are persistent cough, sputum and hemoptysis, which are easy to identify. Pay attention to the following points:
1. History: After pneumonia, whooping cough, measles, long-term cough, cough and repeated lung infections, can be suspected of bronchiectasis, suffering from bronchial lymph node tuberculosis accompanied by persistent atelectasis, the area may be expanded.
2. Clinical features: repeated pulmonary infection, fixed lesions, and difficult to explain general bronchitis or pneumonia; unexplained hemoptysis; various causes of atelectasis, the original cause has been lifted, etc., should Consider the possibility of bronchiectasis.
3. If the bronchial shadow is enlarged in the X-ray film of the lung, or there is a triangular dense shadow near the bottom of the lung, it is likely to have bronchiectasis. In any of the above cases, it should be taken by deep exposure. Tablet or bronchography, high resolution CT to determine the diagnosis.
Differential diagnosis
The disease needs to be differentiated from chronic tuberculosis, chronic bronchitis, lung abscess, congenital pulmonary cyst, pulmonary isolation, paragonimiasis, etc. Regarding hemoptysis, it should be differentiated from pediatric tuberculosis and paragonimiasis, and tuberculosis should be checked from sputum. Pneumocystis, tuberculin test and paragonimiasis antigen skin test, have identification value, X-ray examination is very helpful for differential diagnosis.
