A 6 yr old girl with non productive cough, mild stridor for 3 months duration following a lower respiratory tract infection. Patient is improving but suddenly developed wheeze productive cough mild fever and hyperlucency on CXR and PFT shows obstructive curve. Diagnosis is:
Bronchiolitis obliterans is a rare chronic obstructive lung disease characterized by complete obliteration of the small airways following a severe insult. The most common form in children is postinfectious, following a lower airway tract infection with adenovirus, although influenza, rubeola, Bordetella, and Mycoplasma are also implicated. Persons with bronchiolitis obliterans usually experience dyspnea, coughing, and exercise intolerance. This diagnosis should be considered in children with persistent cough, wheezing, crackles, or hypoxemia persisting longer than 60 days following a lower respiratory tract infection. Chest radiograph abnormalities include evidence of heterogeneous air trapping and airway wall thickening.Ventilation-perfusion scans show a pattern of ventilation and perfusion mismatch. Pulmonary angiograms reveal decreased vasculature in involved lung, and bronchograms show marked pruning of the bronchial tree. Classic findings on chest high-resolution CT include a mosaic perfusion pattern, vascular attenuation, and central bronchiectasis. Suppoive care including supplemental oxygen for hypoxemia, routine vaccination, avoidance of environmental irritant exposure, exercise, and nutritional suppo should be provided. Ongoing airway damage due to problems such as aspiration should be prevented. Inhaled bronchodilators may reverse airway obstruction if the disease has a reactive component. Coicosteroids (inhaled, daily, or pulse dosing) may help reverse the obstruction or prevent ongoing damage. Ref: Federico M.J., Stillwell P., Deterding R.R., Baker C.D., Balasubramaniam V., Zemanick E.T., Sagel S.D., Halbower A., Burg C.J., Kerby G.S. (2012). Chapter 19. Respiratory Tract & Mediastinum. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Bronchiolitis obliterans
Hemosiderosis
Pulmonary alveolar microlithiasis
Follicular bronchitis