D2.481 - Severe obstructive syndrome in children with bronchopulmonary malformations

Introduction: Broncho-obstructive syndrome in children represents a clinical complex caused by partial or complete obstruction of the lower airways. This condition manifests through wheezing, persistent cough, and dyspnea and is observed in bronchial asthma, bronchiolitis, as well as in certain congenital bronchopulmonary malformations (tracheobronchomalacia, tracheal bronchus, cystic formations, etc.), often presenting early in the first years of life. Triggering factors for broncho-obstructive syndrome include viral respiratory infections, exposure to allergens, and specific anatomical features of the bronchial tree, as well as congenital anomalies of the respiratory tract.

Aim: To evaluate severe obstructive syndrome in the context of bronchopulmonary malformations with early onset during infancy.

Materials and Methods: We present the case of an infant hospitalized at the Mother and Child Institute with severe obstructive syndrome and respiratory failure. Imaging studies included chest computed tomography (CT).

Results: At admission, the infant was in critical, life-threatening condition. Clinical examination revealed gray-cyanotic and dry skin, scleral hemorrhagic petechiae, tachypnea, wheezing, marked subcostal retractions, an emphysematous chest, decreased breath sounds on the right, and crackles and wheezes on the left. The patient was placed on ventilatory support (VAP) with FiO₂ 50%. Chest CT showed intrapulmonary cystic formations on the right, suggestive of congenital pulmonary adenomatoid malformation (Stocker type I); a reduced-size right lung with interstitial emphysema; pneumonic infiltrates in segments S2, S6, and S10 of the right lung; a minor right-sided pneumothorax; passive atelectasis due to compression of the right lung; and mediastinal shift to the right. During pregnancy, the mother had a urinary tract infection treated with antibacterial therapy, which may have negatively influenced fetal organogenesis.

Conclusions: Early identification and appropriate management are essential to reduce the risk of complications and to optimize respiratory prognosis in bronchopulmonary malformations, which may present with severe obstructive syndrome. Continuous advances in medical technologies, as well as in prenatal prevention strategies, diagnosis, and treatment of bronchial obstruction, represent a priority direction in modern pediatrics.