PTB airway compression complicated by vascular abnormalities and cardiac involvement: A case series demonstrating diagnosis and management

P Goussard; E Eber; J Janson; A G Gie; B Fourie; C M Jacobs; S S B Venkatakrishna; S Andronikou; S Van der Westhuizen; P Schubert; C Burger; J Verster; L Ebert; E Deininger-Czermak

doi:10.1002/ppul.27351

PTB airway compression complicated by vascular abnormalities and cardiac involvement: A case series demonstrating diagnosis and management

Pediatr Pulmonol. 2024 Oct 28. doi: 10.1002/ppul.27351. Online ahead of print.

Authors

P Goussard¹, E Eber², J Janson³, A G Gie¹, B Fourie¹, C M Jacobs¹, S S B Venkatakrishna⁴, S Andronikou^{4

5}, S Van der Westhuizen³, P Schubert⁶, C Burger⁷, J Verster⁸, L Ebert⁹, E Deininger-Czermak^{10

11}

Affiliations

¹ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
² Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
³ Department of Surgical Sciences, Division of Thoracic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁴ Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁵ Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶ Department of Pathology, Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa.
⁷ Department of Medical Imaging and Clinical Oncology, Division of Nuclear Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁸ Department of Pathology, Division of Forensic Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Forensic Pathology Service, Tygerberg, Cape Town, South Africa.
⁹ Biometrie, Bildforensik, Forensisches Institut Zürich, Zurich, Switzerland.
¹⁰ Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
¹¹ Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

PMID: 39467103
DOI: 10.1002/ppul.27351

Abstract

Introduction: Lymphobronchial tuberculosis (LBTB) is a tuberculous lymphadenopathy causing airway compression in young children. While it can occur in older children due to factors such as airway size, wall weakness, and immune reconstitutions, severe airway obstruction is more common in younger children.

Methods: Chest X-rays show airway compression, while bronchoscopy is the gold standard for confirming TB-induced airway compression. Previous research has demonstrated that drug resistance and HIV have no effect on the outcome of children with significant airway compression caused by TB.

Results: This case series describes the management and outcome of three young children who had simultaneous vascular abnormalities and airway obstruction due to pulmonary tuberculosis (PTB). Concomitant PTB and vascular abnormalities are uncommon, even in high-TB-intensity areas, and affected children may present differently and require individualised treatment.

Conclusions: Advanced imaging is critical for detecting complicated cases of airway compression due to PTB in young children, as vascular abnormalities are uncommon. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) may show metabolically active intracardiac lesions. Individualised management plans are required for these children, and echocardiography is critical for patients with disseminated disease.

Keywords: bronchoscopy; chest CT scan; complicated pulmonary tuberculosis; intrapulmonary sequestration; patent ductus arteriosus.

Grants and funding

None