A 5-year-old girl is admitted to your Paeds ward. The parents give the history that the child has had recurrent, intermittent episodes of fever and respiratory distress over the past 1.5 years, including cough, wheezing, and dyspnea lasting for 3-4 days. With every episode, hemoptysis is present. Now she is diagnosed with Right lower lobe pneumonia which improves upon treatment. On physical examination, the patient is pale, icteric with digital clubbing. Which of the following is the most appropriate next Investigation?
Above Findings are most likely suggestive of a diagnosis of Idiopathic Pulmonary Hemosiderosis. Clinical feature:- Hemoptysis with wheezing, cough, dyspnea (reflecting bronchospasm) and non-pulmonary symptoms such as failure to thrive or jaundice. During an acute exacerbation, children are frequently febrile. Examination of the chest may reveal retractions and differential or decreased aeration, with crackles or wheezes. Investigation Flexible bronchoscopy - Areas of active bleeding. Bronchoalveolar lavage - pulmonary secretions may be sent for pathologic review (which may show hemosiderin laden macrophages) and culture analysis Chest x-ray- Infiltrates are typically symmetric with apices spared Lung biopsy may be required. Treatment Suppoive therapy, including volume resuscitation, ventilatory suppo, supplemental oxygen, and transfusion of blood products Specific Treatment- Methylprednisolone
Modified barium swallow study to evaluate for aspiration
Bronchoalveolar lavage
Nasal swab for viral culture
Incentive spirometry
Other Respiratory Disorders