Daily Archive 01.12.2019

Bronchiectasis in children

Bronchiectasis is an irreversible local expansion of the bronchi, accompanied by infection.

Etiology and pathogenesis of bronchiectasis

The disease is polyetiological. The main factors contributing to the formation of bronchiectasis: congenital lung defects; recurrent non-specific inflammatory diseases of the respiratory system; childhood infectious diseases (measles, whooping cough) foreign bodies of the tracheobronchial tree, tuberculosis, some hereditary diseases and systemic lesions (cystic fibrosis, Cartagener syndrome, agammaglobulinemia); bacterial destruction of the lungs. There are various theories of the pathogenesis of bronchiectatic disease. Some authors consider the main significance of chronic bronchitis, others consider pneumosclerosis to be primary, and others – malformations and inferiority of the bronchopulmonary system. The main importance in the pathogenesis of bronchiectasis is the interaction of two factors: the inflammatory process and the violation of the drainage function of the bronchi. An important role in the occurrence of bronchiectasis is played by atelectases of various genesis (congenital, aspiration, pneumonic, with foreign bodies, bronchial tumors, with cystic fibrosis, with compression by bronchial lymph nodes). It is not excluded that nasopharyngeal diseases (rhinosinusopathies) are associated with bronchiectasis. With joint inflammation of the nasopharynx and lungs, a reactive increase in the lymph nodes of the submandibular region, neck, mediastinum, paratracheal and bronchopulmonary arises. Enlarged lymph nodes are not only a source of infection, but also a factor that disrupts pulmonary blood flow, which contributes to the development of chronic pneumonia. Thus, the pathogenesis of bronchiectasis is a chain of pathological processes that interact and affect each other.

Classification of bronchiectasis

Classification of bronchiectasis. F. Isakov, E. A. Stepanov, V. I. Geraskin (1978).
By origin:
congenital (dysontogenetic), acquired (atelectatic, emphysematous, mixed).
In shape:
cylindrical, bubble-frequent, brush-like.
For distribution:
unilateral, bilateral (large, non-distributed), – with an indication of the segment.
By the severity of bronchitis:
localized, diffuse.
With the course:
with exacerbations (frequent, rare).

Clinic of bronchiectasis

The clinical picture depends on the spread of the lesion, the severity and spread of bronchitis in the unaffected areas of the lung, on the presence of exacerbation or remission. The general condition may be slightly impaired, but with a common process, symptoms of intoxication join early. Children quickly tire, vststayuturouroz-turn. Hemoptysis is rare. With limited bronchiectasis, shortness of breath at rest is usually not observed, with bilateral damage – severe shortness of breath with little physical exertion. Some children complain of headache, bone pain. During periods of exacerbation, the amount of sputum increases, coughing throughout the day is constant, shortness of breath intensifies or appears, fever, more often to subfebrile numbers. One of the most important diagnostic signs of chronic pulmonary disease is chest deformity – chest retraction on the side of the lesion, its lag in the act respiration, a slight omission of the angle of the scapula, rapprochement of the ribs, narrowing of the intercostal spaces. Auscultatory moist rales of various sizes, decreasing after expectoration of sputum.

Diagnosis of bronchiectasis

An X-ray examination of the chest can reveal a spotted eclipse of the affected lobe of the lung, the presence of bronchiectasis is further confirmed by computed tomography. However, the main method to establish a diagnosis of bronchiectasis is bronchography – a contrast study of the bronchial tree. Evaluation of the bronchogram allows you to determine the localization of bronchiectasis, their distribution , form. Changes found during angiopulmonography of children with bronchiectasis depend on the depth and prevalence of pa process in the bronchi and lung parenchyma. The complete absence of blood flow in the affected areas of the lung indicates a functional failure and the need to remove these areas, which are only cells of purulent intoxication.

Treatment of bronchiectasis

Conservative treatment is used as a preoperative preparation in the postoperative period and is aimed at maximizing the rehabilitation of the tracheobronchial tree, as well as all associated foci of inflammation. For the rehabilitation of the trachea and bronchi, bronchoscopy is used, which is repeated 2-3 times. Inhalations, exercise therapy are prescribed. postural drainage, bronchial and mucolytics, vitamins, desensitizing agents. During surgical treatment, the volume of resection is determined according to bronchography and is specified during the operation. Resection of the lobe, several segments of two lobes of the lung is performed (with localization on the right), very rarely it is necessary to remove the entire lung – pulmonectomy. In case of bilateral localization of bronchiectasis, the operation is performed in 2 stages at intervals of 6-12 months.