דלקות ריאה חוזרות

1. * חשוב ! בבחינה דלקות ריאה חוזרות דר. דוד שוסיוב היחידה למחלות ריאה בילדים בית חולים הדסה ירושלים

2. Recurrent pneumonia is defined as at least 2 pneumonia episodes in a 1-year period or at least 3 during a lifetime. * חשוב ! בבחינה Definition

3. Recurrent Pneumonia • Recurrent pneumonia constitutes a threat to the integrity and normal development of the respiratory system • Every possible effort should be performed to make the correct diagnosis and treatment

4. Recurrent Pneumonia * חשוב ! בבחינה • localized • foreign body aspiration • congenital anomalies • asthma • mucoid impaction • diffuse • Cystic Fibrosis (CF) • Immunodeficiency • Primary Ciliary Dyskinesia (PCD) • Aspiration syndromes • Vasculitis *

5. Recurrent Pneumonia • localized • foreign body aspiration • congenital anomalies • asthma • mucoid impaction

6. Aspiration of a foreign body to the airway can endanger life immediately, or in the long term due to chronic lung infection and bronchiectasis • the main goals of the treatment of foreign bodies are: • prevention • early diagnosis • Intervention Foreign Body Aspiration in Children

7. The diagnosis is some times very difficult as there is often no: • leading history • typical physical examination • radiographic findings. Foreign Body Aspiration in Children *

8. Rigid Bronchoscopy

9. 8 months old infant developed a sudden cough while crawling on the floor. • examination revealed diminished breath sounds over the right lung Foreign Body Aspiration in Children

11. A 14 months old girl choked during eating chicken soup • on examination she was tachypneic and dispneic. breaths sounds were normal over both lungs • chest radiograph was normal • fluoroscopy was interpreted as normal Foreign Body Aspiration in Children

12. Foreign Body Aspiration in Children • Due to her critical condition, rigid bronchoscopy was performed demonstrating a hollow chicken bone in the left main bronchus

13. Revision of the fluoroscopy film revealed the chicken bone located in the left main bronchus Foreign Body Aspiration in Children

14. A 3 year old girl was transferred from another hospital due to a severe asthma attack which did not respond to high doses of IV steroids and inhaled bronchodilators • Examination revealed normal breaths sound while lying supine, however in the seating position she developed severe respiratory distress Foreign Body Aspiration in Children

15. Rigid bronchoscopy demonstrated a swollen watermelon seed sliding along the trachea Foreign Body Aspiration in Children

16. Inflammatory pseudo-polyp • A 3 years old boy was referred to evaluate recurrent RLL pneumonia • Bronchoscopy revealed a polypoid mass obstructing the Rt. main bronchus

17. Inflammatory pseudo-polyp • After removing the polypoid mass, a small piece of almond was seen

18. Rigid bronchoscopies performed for suspected foreign body aspiration in children - results of 173 procedures

19. Rigid bronchoscopies performed for suspected foreign body aspiration in children *

20. Rigid bronchoscopies performed for suspected foreign body aspiration in children - history

21. Rigid bronchoscopies performed for suspected foreign body aspiration physical examination

22. Rigid bronchoscopies performed for suspected foreign body aspiration in children - Chest X ray

23. Rigid bronchoscopies performed for suspected foreign body aspiration in children -Yield of 86 fluoroscopies P=0.034

24. The prediction of foreign body aspiration is best achieved by: • 1. history • 2. physical examination • 3. chest radiography Indications for Bronchoscopy for Suspected Foreign Aspiration *

25. Recurrent Pneumonia • localized • foreign body aspiration • congenital anomalies • asthma • mucoid impaction

26. distorted structure • sequestration • cystic adenomatoidmalformation (CCAM) • airway obstruction • Stenosis • Malacia • external compression • vascular rings, slings • cysts Recurrent PneumoniaCongenital anomalies

27. Cong Cystic Adenomatoid Malformation - CCAM

28. Pulmonary sequestration Angiography with systemic circulation

29. Bronchomalacia - LMB

30. Bronchomalacia - LMB

31. Bronchomalacia - LMB

32. Bronchial stenosis

33. Normal aortic arch ? Double aortic arch

34. Recurrent Pneumonia • localized • foreign body aspiration • congenital anomalies • asthma • mucoid impaction

35. Asthma Right middle lobe syndrome * !

36. Recurrent Pneumonia • localized • foreign body aspiration • congenital anomalies • asthma • mucoid impaction

37. Mucoid impaction: bronchial cast eosinophils dehydrated secertions Associated with: Post heart surgery * cystic fibrosis asthma allergic bronchopulmonary aspergillosis (ABPA)

38. Recurrent Pneumonia • diffuse • cystic fibrosis • immunodeficiencies • primary ciliary dyskinesia • aspiration syndromes

39. Recurrent Pneumonia • diffuse • cystic fibrosis • immunodeficiencies • primary ciliary dyskinesia • aspiration syndromes

40. Agammaglobulinemia - x linked • IgG subclass deficiency • Complement deficiency • Neutrophil abnormalities: • Schwachman-Diamond syndrome • Chronic granulomatous diseae (CGD) • Chediac-Higashi syndrome • Job’s syndrome (תסמונת איוב) • cyclic neutropenia • drug induced neutropenia Immunodeficiencies

41. Recurrent Pneumonia • diffuse • cystic fibrosis • immunodeficiencies • primary ciliary dyskinesia (PCD) !! • aspiration syndromes

42. chronic sinusitis • chronic and rec. otitis media • recurrent pneumonia & bronchiectasis • situs inversus (50%) • male infertility (50%) • Females some problems • Low Nasal Nitric Oxide (NO) Primary ciliarydyskinesia

45. PCD maxillary sinusitis

46. PCD maxillary sinusitis

48. Normal cilium

49. PCD

50. PCD dysorientation of central tubules