The investigation of clinical symptoms and radiological findings in patients with airway anomalies detected by bronchoscopy method

Kurtoğlu, C., The Investigation of Clinical Symptoms and Radiological Findings in Patients with Airway Anomalies Detected by Bronchoscopy Method, Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara, 2024. Tracheobronchial anomalies are significant health issues affecting respiratory functions in the pediatric age group and are frequently encountered in pediatric chest disease clinics. Currently, the most widely accepted method for demonstrating tracheobronchial anomalies is flexible fiberoptic bronchoscopy. In this cross-sectional study, a total of 842 flexible fiberoptic bronchoscopy procedures performed between January 1, 2015, and January 1, 2023, in the Pediatric Chest Diseases Department of Hacettepe University Ihsan Dogramaci Children's Hospital were examined in children aged 0-18 years. Of these, 387 patients who had bronchoscopic findings from the 842 flexible fiberoptic bronchoscopy procedures and had thoracic computed tomography imaging within the last year before bronchoscopy were included in the study. The patients were examined in terms of their demographic and clinical characteristics, presenting complaints, and bronchoscopy findings compared to their radiological findings, as well as in terms of bronchoalveolar lavage macroscopy and cytology features. The mean age at which bronchoscopy was performed for patients was 7.72±5.35 years. Of the patients, 54.8% were male, and 45.2% were female. The most common presenting complaint among patients (38%) and the most common indication for flexible bronchoscopy (30%) was recurrent lung infections. Following recurrent lung infections, the most common presenting complaints or findings were chronic cough (33.9%) and wheezing (10.1%). The most commonly identified pathology on bronchoscopy in our study group was purulent secretion (52.2%). While bronchomalacia (24.5%) and tracheomalacia (23.5%) were the most frequently detected airway anomalies bronchoscopically, the left main bronchus (12.1%) was the most commonly affected bronchus in bronchomalacia. The most common radiological finding on pre-bronchoscopy thoracic computed tomography examinations of patients was subsegmental or linear atelectasis (53.0% in the left lung, 48.1% in the right lung). It was observed that bronchial stenosis (9.5% in the right main bronchus, 20% in the left main bronchus) were more commonly encountered radiologically in patients with bronchomalacia (p=0.003, p<0.001). Additionally, bronchiectasis in the right middle lobe, right lower lobe, and left lower lobe (7.7%, 7.7%, 15.8%, respectively), peribronchial thickening (32.6%, p=0.024), and mucus plugs (9.5%, p=0.026) were observed at lower rates in these patients. The sensitivity of thoracic computed tomography in diagnosing bronchomalacia was found to be 26.30%, with a specificity of 95.90%; for tracheomalacia diagnosis, the sensitivity was 26.40%, with a specificity of 97.60%. In conclusion, in patients presenting with recurrent lung infections, chronic cough, wheezing, or radiological findings such as resistant atelectasis, infiltration, all tracheobronchial anomalies, especially airway malacias, should be kept in mind. Advanced radiological examination and flexible bronchoscopy should be considered when suspecting tracheobronchial anomalies in patients with these complaints and findings.