Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Foreign body aspiration in children

Background: Foreign Body (FB) aspiration is a life-threatening problem in children. Here the demographic pattern, clinical presentation, type of Foreign Body (FB) and outcome of FB aspiration was examined.Methods: An observational case series study done in Institute of child health and research centre, Government Rajaji hospital, Madurai during November 2015 to June 2018. After a detailed history and clinical examination, children with definite evidence of FB in tracheobronchial tree were subjected to rigid bronchoscopy and with doubtful evidence were subject to FFBS. They were followed up for complications.Results: Of the 136 children, 86.03% (n=117) were under 3 years of age. A positive history of FB aspiration was present only in 51.4% (n=70). Unilateral hyperinflation was seen in 48.53% (n=66) but was normal in 13.97% (n=19). Flexible Fiber Optic Bronchoscopy (FFBS) diagnosed FBs in 61.02% (n=83) which included children with acute onset breathlessness and persistent radiological features. Peanut was the most common FB 64.71% (n=44). FBs were found in the right side in 50% (n=34) and in the left in 38.2% (n=26).' 36% (n=49) developed complications due to the FBs and 2.9% (n=4) due to procedure.Conclusions: FB aspiration is most common in children less than 3 years of age. Positive history of aspiration was seen in only 51.4% and chest X-ray was normal in 13.97%. FFBS diagnosed FB in 61.02%. Peanut was the most common FB. Persistent pneumonitis is the most common complication.

Rol de la endoscopía en la lesión traumática de la vía aérea / Role of endoscopy in traumatic airway injury

Las lesiones del árbol traqueobronquial (aTB) es un evento no frecuente, pero con un alto riesgo de vida. La causa puede ser iatrogénica, secundaria a procedimientos médico y traumática por trauma cerrado o penetrante. Su incidencia no se conoce exactamente. La dificultad para establecer la incidencia de la lesión traumática se debe a que un 30 a 80% de las víctimas de trauma fallecen en el lugar del accidente por las lesiones asociadas. El pronóstico de los pacientes que logran llegar al hospital va a depender esencialmente de las características de la lesión en la vía aérea (VA) y las lesiones asociadas.

Injuries to the tracheobronchial tree (aTB) is an uncommon event, but with a high risk of life. The cause can be iatrogenic, secondary to medical and traumatic procedures by closed or penetrating trauma. Its incidence is not exactly known. The difficulty in establishing the incidence of the traumatic injury is due to the fact that 30 to 80% of trauma victims die at the scene of the accident due to the associated injuries. The prognosis of patients who reach the hospital will depend essentially on the characteristics of the airway (VA) lesion and associated lesions.

Retrieval of Fractured Metallic Tracheostomy Tube – An Innovative Approach.

Permanent tracheostomy following total laryngectomy is a common practice. Distal migration of fractured tracheostomy tube in such patient is a rare complication. We report this rare occurrence in which flexible bronchoscopy guided retrieval of migrated tracheostomy tube was failed. We applied an innovative approach to safely remove the migrated fractured metallic tracheostomy tube.

AIRWAY FOREIGN BODY DIAGNOSIS AND TREATMENT / Мэс засал

Introduction: The aim of this study was tostudy the pattern of foreign-body aspiration inthe tracheobronchial tree as well as the successrate of rigid bronchoscopy in children admittedto the National Center for Maternal and ChildHealth, Mongolia during 2012-2016.Materials and Methods: In this crosssectionaldescriptive study, the required datawere collected from the medical reports ofall children under the age of 13 years withsuspected foreign-body aspiration who wereadmitted and underwent explorative flexibleand rigid bronchoscopy during 2012-2016. Thedata was retrospective viewed.Results: Among 40 patients with aconfirmed aspiration, 57.5% (23) were malesand 42.5% (17) were females. 42.5% were1-3 years old. The most common complaints(symptoms) of patients were non-productivecough (82.5%), wheezing (52.5%) andrespiratory distress (22.5%). The mostfrequently aspirated foreign bodies were nuts(peanuts). In total, 57.5% of foreign bodieswere lodged in the right bronchial tree. In 100%of cases, the foreign body was completelyextracted by bronchoscope. The majority ofcases were admitted more than 24 hours afterthe occurrence of aspiration, and pneumoniawas the most common complication. In X-rayfindings Golitsknyekhta Yakobsona’s symptomswere in 10 /25%/ cases.Conclusion: Patient history, especiallyinitial suspicion of aspiration, coughing,wheezing and respiratory distress, can behelpful in the diagnosis of foreign-bodyaspiration. All foreign bodies were removed bybronchoscope /100%/ without complications.In X-ray findings Golitsknyekhta Yakobsona’ssymptoms were in 10 /25%/ cases.

Foreign Body in Tracheobronchial Tree

A two year experience with the treatment of 50 patients (86% children) who were admitted for foreign body aspiration in the department of otorhinolaryngology and Head and Neck Surgery is reviewed. The object of this study was to show the clinical manifestations, the radiological findings, the nature and distribution in the tracheobronchial tree and complications due to long standing foreign bodies in the bronchial tree. Males (35) were more commonly involved as compared to females (15) in the ratio of 2.3:1. Right main bronchus was involved in 24 patients (48%), left main bronchus in 15 patients (30%) and trachea in 11 patients (22%). The most common foreign bodies found were beans (24%), peas (18%), and corns (10%). The most frequent clinical manifestation was choking (60%) and the most frequent radiological finding was atelectasis (44%). The most serious complication was pneumothorax in 2 patients who needed intercostal chest tube. In conclusion, inspite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed because sudden choking at the time of aspiration in children may not be noticed.

A Case of Relapsing Polychondritis Presenting As a Diffuse Tracheobronchial Tree Involvement / 결핵

Relapsing polychondritis (RP) is a rare inflammatory disorder of unknown etiology, causing recurrent inflammatory and degenerative reactions involving the cartilaginous structures throughout the body. Generally, RP is known as multiorgan disease presented as auricular chondritis, arthritis, nasal chondritis, ocular inflammation, audiovestibular damage and respiratory tract inflammation. Major airway involvement occurs in more than 50% of the patient and has been reported to be the primary cause of death. Rarely, it may be presented with only respiratory symptoms without typical clinical manifestation of RP. We experienced a 64-year-old male patient with RP involving diffuse airway tract without other characteristic clinical manifestation and present here with a review of literatures.