Flexible Bronchoscopy in Non-resolving Pneumonia
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To study the utility of diagnostic flexible bronchoscopy and bronchoalveolar lavage (BAL) in children with non-resolving pneumonia.
This was a cross-sectional study conducted in a tertiary care hospital from July 2015 through June 2016. Fifty-two consecutive children of both genders from 1 mo to 14 y of age with a diagnosis of non-resolving pneumonia were included. Flexible bronchoscopy was done in all patients with or without bronchoalveolar lavage (BAL). BAL was sent for gram staining, culture, gene expert™ and lipid laden macrophages examination. Main outcome measures were to find any morphological abnormality in the tracheobronchial tree and organism profile of a positive BAL culture.
During the period of 12 mo, 52 consecutive patients of non-resolving pneumonia were enrolled. Median (IQR) age of the study population was 12 (68.8) mo. Mean ± SD duration of illness was 22.7 ± 5.6 d. Flexible bronchoscopy was found to be very safe and effective tool that directly led to definitive diagnosis in 30.7% of cases. It was positive for different organisms in 22 (52.3%) children. Neglected foreign body was seen in five patients.
Non-resolving pneumonia is often an area of clinical dilemma. Bacterial infections are the commonest etiology. Non-infectious causes like tracheobronchomalacia and foreign body aspiration are other important etiologies to be looked for. Early bronchoscopy and bronchoalveolar lavage analysis can play a crucial role in the evaluation of these patients and may provide an important clue or strongly support the specific diagnosis.
KeywordsBronchoalveolar lavage Bronchoscopy Non resolving pneumonia
JIB and WAW: Collected and compiled the data for thestudy, and drafted the manuscript; BAC and SWA: Conceptualized anddesigned the study; QIA: Finalized the manuscript; AAA: Did statistical analysis and intermittentdata check. MA: Involved in revising the manuscript and helped in data collection. Critical review was performed by all. JIB will act as guarantor for the paper.
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