Clinical Research Of24Cases Of Bronchiolitis Obliterans In Children

Objective:To analyse the clinical features of the bronchiolitis obliterans (BO) in children, and to improve the understanding of the BO in children for clinical physicians.Methods:A retrospectively research was done to study the Clinical data of24in-patients clinically diagnosed with BO in Children’s Hospital Affiliated to Chongqing University of Medical Sciences from July.2007to Feb.2009. our aim was to analyse the characteristics of clinical manifestations, etiology, pulmonary imaging and lung function, and to discuss the therapy and prognosis.Results:(1) Clinical manifestations:24cases presented with persistent cough and wheezing,20cases had Shortness of breath after motion,11cases had dyspnea, and3cases had exercise intolerance. Wheezing was heard in24cases and crackles in23cases, retraction was seen in20cases and clubbing finger in one case.(2) Etiology:nineteen cases (79.2%) were Post-infectious bronchiolitis obliterans (PIBO), among whom11cases (57.9%) were supposed to occurred after adenovirus pneumonia,2(10.5%) after measles pneumonia,2(10.5%) after influenza virus A pneumonia, one (5.3%) after mycoplasma pneumoniae pneumonia, one (5.3%) after mycoplasma pneumoniae coinfection with adenovirus pneumonia, one (5.3%) after respiratory syncytial virus coinfection with Parainfluenza type3virus pneumonia, one (5.3%) after pulmonary tuberculosis. One case (4.2%) respectively occurred after Steven-Johnson syndrome, Paraneoplastic pemphigus and Hematopoietic stem cell transplantation. The etiology was unknown in2cases (8.3%).(3) The features of pulmonary imaging and lung function:pulmonary CT was taken in all24cases, among whom the areas of decreased density was seen in21cases (87.5%), mosaic perfusion in15cases (62.5%), bronchiectasis in9cases (37.5%), bronchial wall thickening in9cases (37.5%), and air trapping in4cases (16.7%). Lung function test was performed in17cases, revealing obstructive ventilation disorder in all cases, among whom14cases had bronchodilation test with13(92.9%) negative result.(4) The therapy and prognosis:24cases received corticosteroid inhalation,22cases oral corticosteroid, and20cases oral low doses of azithromycin. One case died in hospital. Sixteen cases were followed up for1month to4years and seven month, the outcome of these cases included clinical manifestations improvement in11cases (68.8%), no improvement in4cases (25%) and one case(6.3%) died.Conclusion:In children, most BO cases occurred among infants and toddlers, BO have no characteristic clinical manifestations. Most BO cases in children are associated with infections, especially adenovirus infection. The areas of decreased density and mosaic perfusion are the major signs in pulmonary CT imaging, lung function typically show fixed airflow obstruction. The overall prognosis is unsatisfactory, PIBO has a relatively good outcome, early diagnosis and persistent treatment may help to improve the prognosis.