Page 13 / April 07
There are some possibilities to explain this late presentation as followings;
In summary this girl has a history of recurrent hemoptysis with failure to thrive and digital clubbing. She was diagnosed as having asthma and had a persistent cough, aggravated by eating and running. The chest x-ray revealed persistent ill-defined opacities and patchy densities seen at the perihilar area and superior segment of the right lower lobe. The coagulogram, immunology workup and tuberculin skin test were all negative. CT scan chest, bronchoscopy, and gastroscopy confirmed an abnormal communication between the esophagus and the right lower lobe bronchus. The lobectomy and fistulectomy was done. Pneumonia was treated by Cefuroxime and Clarithromycin. The Bronchoalveolar lavage fluid cultures grew only Candida Albicans which can be found as normal flora. The pathology results suggest a bronchopulmonary foregut malformation with aspiration pneumonia, bronchopneumonia, lymphocytic bronchiolitis, intra-alveolar hemorrhage and bronchiectasis. The patient was discharged home safely 9 days after operation. The follow-up plan was arranged to perform chest x-ray, repeat esophagography and spirometry with bronchodilator response.
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ANSWER:
There are some possibilities to explain this late presentation as followings;
- There was a membrane that subsequently ruptures
- There was an esophageal mucosal fold that subsequently less mobile
- The fistula tract may close during swallowing
Summary
In summary this girl has a history of recurrent hemoptysis with failure to thrive and digital clubbing. She was diagnosed as having asthma and had a persistent cough, aggravated by eating and running. The chest x-ray revealed persistent ill-defined opacities and patchy densities seen at the perihilar area and superior segment of the right lower lobe. The coagulogram, immunology workup and tuberculin skin test were all negative. CT scan chest, bronchoscopy, and gastroscopy confirmed an abnormal communication between the esophagus and the right lower lobe bronchus. The lobectomy and fistulectomy was done. Pneumonia was treated by Cefuroxime and Clarithromycin. The Bronchoalveolar lavage fluid cultures grew only Candida Albicans which can be found as normal flora. The pathology results suggest a bronchopulmonary foregut malformation with aspiration pneumonia, bronchopneumonia, lymphocytic bronchiolitis, intra-alveolar hemorrhage and bronchiectasis. The patient was discharged home safely 9 days after operation. The follow-up plan was arranged to perform chest x-ray, repeat esophagography and spirometry with bronchodilator response.
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