Chronic Pulmonary Suppuration Research Articles

Tracheobronchomegaly (Mounier-Kuhn Syndrome) in Old Age - A Case Report

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare condition affecting the airways and is characterized by dilatation of the trachea and major bronchi secondary to atrophic or absent elastic fibres of the cartilage and thinning of the muscles.[1] The abnormally enlarged flaccid portions of the bronchial tree collapse and fail to maintain patency during expiration and coughing, predisposing the patient to stagnation of contents and recurrent lower respiratory tract infections, emphysema, bronchiectasis and chronic pulmonary suppuration.[2] The diagnosis is usually made on basis of specific radiographic features,[3] particularly on computed tomography (CT) scan. We report a case of a 69-year-old man who presented with recurrent lower respiratory tract infections and was found to have tracheobronchomegaly as an underlying primary airway abnormality on imaging and bronchoscopy that was initially undiagnosed.

Multidisciplinary approach to paediatric aerodigestive disorders: A single-centre longitudinal observational study.

Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.

Cough suppression disorders spectrum

Volitional cough suppression, identified exclusively in females, is an unusual causal mechanism for instances of lobar atalectasis and bronchiectasis. It is a postulated mechanism for the genesis of Lady Windermere Syndrome.

Doença cística traqueobrônquica

Cistos aéreos que emergem anormalmente da traquéia e/ou brônquios de maior calibre são doença extremamente rara. Na literatura encontram-se poucas descrições de casos isolados de cistos paratraqueais associados a pneumopatias crônicas. Relatamos dois casos dessa entidade clínica, rara, em membros de uma mesma família: o pai das pacientes faleceu dessa doença com 43 anos de idade e as duas filhas encontram-se em tratamento. O quadro clínico é semelhante ao da supuração pulmonar crônica. O diagnóstico foi firmado através de broncovideoscopia e tomografia computadorizada de tórax com reconstrução em 3D e broncoscopia virtual. As pacientes estão sob observação e tratamento clínico paliativo.

Congenital oesophageal respiratory tract fistula presenting in adult life

Congenital oesophageal respiratory tract fistula presenting in adult life is rare. A tracheo-oesophageal and a broncho-oesophageal fistula presenting in a 22 year old female and 68 year male, respectively, are described. In both, symptoms of chronic recurrent pulmonary suppuration were initially attributed to alternative aetiologies, resulting in diagnostic delay and inappropriate management. Correct diagnosis was established by flexible bronchoscopy and oesophageal contrast studies. Surgical division of fistulae resulted in complete symptom resolution.

Congenital tracheobronchomegaly (Mounier-Kuhn syndrome)

Mounier-Kuhn syndrome is a congenital abnormality of the trachea and main bronchi characterized by atrophy or absence of elastic fibers and thinning of muscle, which allows the trachea and main bronchi to become flaccid and markedly dilated on inspiration with narrowing or collapse on expiration or cough. The abnormal airway dynamics and pooling of secretions in broad outpouchings of redundant musculomembranous tissue between the cartilaginous rings predispose to the development of chronic pulmonary suppuration, bronchiectasis, emphysema, and pulmonary fibrosis. A broad spectrum of clinical abnormalities has been documented in Mounier-Kuhn syndrome, ranging from minimal disease with good preservation of pulmonary function to progressive disease leading to respiratory failure and death. In the appropriate clinical setting, Mounier-Kuhn syndrome is diagnosed in women from chest radiographs when the transverse and sagittal diameters of the trachea exceed 21 mm and 23 mm, respectively, and when the transverse diameters of the right and left main bronchi exceed 19.8 mm and 17.4 mm, respectively. In men it is diagnosed when the transverse and sagittal diameters of the trachea exceed 25 mm and 27 mm, respectively, and when the transverse diameters of the right and left main bronchi exceed 21.1 mm and 18.4 mm, respectively. The diagnosis can be confirmed easily by computed tomography.

Total Pneumonectomy

In July, 1931, a 12-year-old girl sustained a crushing injury to the thorax. Tension pneumothorax, which suggested a tear in the left main bronchus, developed. Because of chronic pulmonary suppuration over the next several months, the decision was made to extirpate the left lung. Total pneumonectomy was attempted, but during the operation strong traction on the hilum resulted in temporary asystole. The operation was halted and resumed fourteen days later. The lung was freed and suture ligatures tied around the hilum, central to the bronchial obstruction. Two weeks later the necrotic lung sloughed off. A small bronchial fistula closed spontaneously. The patient lived for several years. Haight and Graham completed successful pneumonectomies in 1933, Graham's procedure being accomplished in one stage. In the 49 years since the first pneumonectomy, little has been added to the technique, save the achievement of superior hemostasis.

Congenital Tracheoesophageal Fistula in the Adult

Congenital tracheoesophageal fistula can persist and remain undetected until adulthood. We have recently encountered such a case and reviewed the others reported in the English literature. Commonly, symptoms are present during infancy, but an occasional patient develops symptoms only later in life. Diagnostic confirmation may be quite difficult, and the esophagogram appears to be the most reliable test. Chronic pulmonary suppuration is unusual, and most tracheoesophageal fistulas may be satisfactorily repaired by way of a cervical approach.

Lipomatous pseudohypertrophy of the pancreas associated with chronic pulmonary suppuration in an adult.

Summary This report describes a man who died at the age of 43 of overwhelming pulmonary suppuration in association with pancreatic steatorrhoea. Autopsy revealed lipomatous pseudohypertrophy of the pancreas. The patient is the longest documented survivor with pulmonary complications of lipomatous pseudohypertrophy of the pancreas. The literature on this rare condition is reviewed.

Congenital oesophago-bronchial fistula in an adult. A case report.

A report of a rare case of benign oesophagobronchial fistula is presented, in a 56-year-old woman with a 40-year history of recurrent pleuritis, haemoptysis and chronic debilitating pulmonary suppuration. The diagnosis was established by oesophagography, a resection of the fistula and lower right lobe was made without complications, recovery was uneventful and the patient is in good health 17 years postoperatively. Oesophagography and, if necessary, bronchography should be performed routinely when evaluating cases of chronic pulmonary suppuration, particularly those of obscure aetiology, even when the symptoms are not accentuated while swallowing.

Benign esophagobronchial fistula. A curable cause of adult pulmonary suppuration.

Benign esophagobronchial fistula is a curable cause of adult chronic pulmonary suppuration which can easily be overlooked. Accumulating case reports in the literature suggest that it occurs more frequently than once thought. 1,2 Within the past year two young adults have had successful operations for benign esophagobronchial fistula at Harbor General Hospital. This report reviews the features of these two cases stressing the need for awareness of this entity, the importance of appropriate diagnostic studies, and the desirability of prompt, curative operation. Report of Cases Case1.—A 22-year-old Negro woman was admitted to Harbor General Hospital for the first time on March 12, 1969, complaining of three days of right pleuritic chest pain and large amounts of foul-smelling sputum with bright red hemoptysis. Right-sided pneumonia with cavitation had first occurred five years previously. Thereafter, cough persisted and became increasingly productive of sputum with intermittent hemoptysis. Multiple admissions to another hospital

“Silent” Gastroesophageal Reflux: An Important but Little Known Cause of Pulmonary Complications

A series of 25 patients with proved gastroesophageal reflux with or without roentgenographically-demonstrable hiatus hernia in whom the digestive abnormality came to light in the course of study for chronic pulmonary suppuration, has been presented. The pulmonary symptoms included bronchitis, often accompanied by hemoptysis, bronchiectasis, unresolved pneumonitis and in one, empyema. While the possibility that these are two relatively frequent co-existing disease states cannot be completely excluded, the fact that esophageal diseases producing dysphagia are known to produce pulmonary sequelae has made it reasonable to reach the same conclusion regarding chronic nocturnal aspiration of gastric contents in the patient with an incompetent cardioesophageal junction. Of 15 patients surgically treated, of whom nine had only repair of their hiatus hernia, both the pulmonary and gastrointestinal symptoms were relieved in all. This experience reaffirms that all patients with pulmonary infection or disease of obscure etiology should be investigated for occult gastroesophageal reflux.

Experience in the surgical treatment of chronic pulmonary suppuration in children

Surgical treatment of chronic nonspecific suppuration of the lungs in children has not yet become widespread. The number of operated children, even in the largest statistics, does not reach 100 cases (A. P. Kolesov and employees, E. G. Dubeykovskaya, S. L. Libov and K. F. Shiryaeva). This report is based on personal observations of the surgical treatment of 91 children operated on for chronic suppuration of the lung.

Chronic Pulmonary Suppuration

The purpose of this paper is to focus attention on present antibiotic treatment of pulmonary suppurative disease, inasmuch as the current literature does not stress medical management. From the literature one receives the impression that in acute suppurative conditions of the lung surgical treatment is still the preferred method of management and that it should be instituted early. In fact, acute pulmonary abscess is still claimed to be a surgical problem from the beginning. While it is true that surgical intervention is required in some cases, it is also true that in other cases medical management alone renders surgery unnecessary. The authors hope that this article will indicate that the concept of surgery a priori as the proper treatment of pulmonary abscess is no longer true. Surgical treatment may be required-but not before medical treatment has first been tried and found to be incompletely effective. Although we believe that present day surgical opinion is no longer so restrictive, the literature does not make clear that a change in concept has occurred. Although this discussion deals with suppurative disease of the lung in general, emphasis is given to lung abscess because that is l’exemple par excellence of pulmonary suppurative disease, concerning which so many articles have been written. In the literature great stress is given to preventing the acute condition from becoming chronic. But the dividing line between acute and chronic stages is at best a hazy and artificial one. Frequently the onset of illness can be only poorly established so that the transition into chronicity can be only poorly determined. Besides, with all the antibiotics that are freely administered today, the course of the disease is affected to a degree that makes the old dictum of six weeks the point where the acute stage ends, no longer true. Moreover, the importance of acute or chronic classification is further lessened by the fact that treatment, up to a certain point, is substantially the same. A brief review of the literature at this point may be profitable. Allen and Blackman, in a series of more than 2,000 cases, collected up to 1936, found a mortality of 34.4 per cent for the medically treated cases. However, the drop in mortality for the cases in the series that received surgical treatment in addition to medical care was only 0.2 per cent. Early surgery was the only means of further lowering this mortality. As early as 1920, Heuer2 performed early drainage in a small group of cases with surprising success. This method became firmly established following the classic articles of Neuhof and Touroff3 who advocated surgical drainage as the best therapy for the acute, putrid lung abscess. The early mortality of 35 per cent was reduced by them to 5 per cent and later to approximately 3 per cent. This led to the era when the diagnosis of lung abscess automatically indicated surgical treatment by drainage. There was general acceptance of their results and conclusions. We, also, agree with them-but only for

Lysozyme levels in cystic fibrosis of the pancreas.

The significance of lysozyme in various body fluids has been discussed in several reviews. 1-3 In general, it is held that lysozyme, as it appears in tears and saliva, exerts a protective influence against bacterial invasion if present in an adequate concentration. Lysozyme exerts its protective effect by hydrolyzing certain structural polysaccharides in the bacterial cell wall, thus causing the dissolution of many bacteria, particularly cocci. Granulocytes 4 also contain lysozyme-like enzymes which are released when the cells are injured. 5-7 In areas where there has been a leukocytic proliferation due either to infection or irritation, relatively high levels of lysozyme may be observed. 4,8 The study of the lysozyme activity of various body fluids from patients with cystic fibrosis was considered to be of interest in view of the almost constant development of chronic pulmonary suppuration in this disease. Abnormally high lysozyme levels were observed in the duodenal fluids

The effect of chronic pulmonary suppuration on the gastric mucosa.

Gastroscopic examination of 17 patients with bronchiectasis or lung abscess revealed a fully normal mucosa in all but two instances, both of which were of minor importance. The ingestion of lesser amounts of purulent material due to purulent gingivitis or chronic sinusitis, therefore, would not appear to be harmful to the gastric mucosa.

The surgical treatment of chronic pulmonary suppuration in children with special reference to bronchiectasis

There can be no doubt, as has been pointed out by others, that the foundation of chronic pulmonary suppuration in adults is often laid during childhood. The radical treatment of this condition during childhood now has a reasonably low operative risk. This risk, with increasing experience, will become even less. Prevention of this condition is, of course, better than its treatment no matter how safe this may become. The group of cases that has as its etiologic agent a foreign body is the most obvious type for which preventive measures are useful. The aspiration of foreign bodies by members of this age group cannot be entirely prevented. The presence of a foreign body, however, should be recognized earlier than is often the case, and its removal effected at the earliest possible moment. In the cases of bronchiectasis in Group II, indications for operation seem clear and the prognosis seems good. But in considering Group II, it is important also to consider the cases cited of pulmonary gangrene. Would some of these have been, at an earlier stage in their disease, operable as regards lobectomy or pneumonectomy? As it is not possible to foretell which cases of pulmonary abscess, with or without chronic pleural infection, will go on to pulmonary gangrene, an earlier radical surgical attack might be made in some instances before the process has extended to such a degree that it is impossible to free the lobe or lobes without rupture of the lung. Many cases of lung abscess in children, however, clear up without radical surgery. It is probable that an earlier and more radical treatment of the so-called “chronic unresolved pneumonia” or “chronic pneumonitis,” that is associated with a fibrinous pleurisy but without appreciable free pleural pus, may prevent the establishment of a bronchiectasis or even gangrene. Further data, especially bacteriologic data, are needed before any absolute conclusions can be drawn as regards the time for election of radical surgery in this type of case. The most difficult sort of case in which to decide on the time for radical surgery is that exemplified by the cases of bronchiectasis in Group III. The duration of symptoms is usually long, and the symptoms are mild. There are a great many cases occurring in childhood in which the patient has repeated attacks of upper respiratory infection associated with cough, particularly during the winter and early spring. It seems unlikely that all such cases go on to bronchiectasis, or the incidence of the disease would be enormous. But do some of these children have a constitutional predilection to chronic pulmonary disease? Or may there be a particular organism that is a predisposing factor in the development of bronchiectasis? That the predominating organisms in the cases of bronchiectasis of Group III were the influenza bacillus and the streptococcus hemolyticus may or may not be significant. It is noteworthy, however, that in all these cases the post-operative course has been slow. The patients have had some mild and repeated attacks of upper respiratory infection since operation, but as yet there is no definite evidence of bronchiectasis developing in their remaining lobes. A good prognosis, however, cannot be assured. Complete and careful bacteriologic studies are much to be desired, and are now being carried out at this hospital. It is hoped that such studies here and elsewhere may give some reliable information on the etiology and prognosis of certain types of bronchiectasis in children.

ROENTGEN THERAPY FOR BRONCHIECTASIS

In a preliminary report one of us 1 reported the effectual use of roentgen therapy for bronchiectasis in a case of bronchiectasis. Here we report our successful experience in thirty cases of bronchiectasis in which roentgen therapy was employed. ROENTGEN THERAPY IN BRONCHIECTASIS Roentgen therapy has been employed for a great and protean variety of pulmonary inflammatory diseases. The literature is voluminous on the subjects of roentgen therapy for pulmonary tuberculosis, postoperative pneumonia, unresolved pneumonia, chronic pulmonary suppuration, pertussis, asthma and bronchitis. 2 Under the obscure headings of chronic pulmonary suppuration and unresolved pneumonia, there were perhaps many cases of unidentified bronchiectasis. Roentgen therapy has been employed in small dosage by several authors for unresolved pneumonia and chronic pulmonary suppuration with varying and, for the most part, indifferent results. In all probability, many cases of unidentified bronchiectasis were previously included under those obscure headings. Experience many years

Chronic pulmonary suppuration and its treatment by bronchoscopy and drainage

Chronic pulmonary suppuration and its treatment by bronchoscopy and drainage

ATELECTASIS IN THE PATHOGENESIS OF ABSCESS OF THE LUNG

Although numerous observations have been made on pulmonary infection in the albino rat, definite knowledge concerning the etiologic agent and the factors in the pathogenesis of this disease is lacking. The lesions of the lungs vary greatly according to the stage and extent of the process, but the essential nature of the completely developed lesions is that of chronic pulmonary suppuration. The late stages of the disease are frequently misnamed pneumonia, while the earlier manifestations of the condition are imperfectly understood. The purpose of the present communication is to present a series of observations which suggest that atelectasis subsequent to bronchial occlusion is a primary factor in the development of this disease. The literature contains numerous assertions on the one hand that the lungs are sterile, and on the other hand that they frequently contain micro-organisms. Thomson and Hewlett1estimated that 1,500 organisms or more were taken into the air