RESULTS
31 children, 15 males and 16 females, mean age at time of referral of
5.64+ 3.62 years, were included in the study. In all children
fiberoptic bronchoscopy demonstrated the presence of pulsatile extrinsic
compression of the trachea middle third, leading to different degree of
narrowing that increased in expiration and, more, during coughing
(figure 1). Mucus/mucopurulent secretions and various degree of
congestion and edema of the airway mucosa were revealed. Chest CT scans
demonstrated the presence of aberrant innominate artery (AIA) in 21
children, right aortic arch (RAA) in 4 children, double aortic arch
(DAA) in 2 child and AIA associated with RAA in 5 children (figure 2).
Analysis of BAL cells demonstrated a significant difference in total
cell numbers, corrected per milliliter of BAL fluid recovered [92.03
(70.15-481.39) cells µL−1], compared to control
values in our laboratory [132.15 (35.15-290.74) cells
µL−1; p<0.01]. A neutrophilic alveolitis
was detected, with 21.50 (10.55-66.10) neutrophil proportion, compared
to control values of 1.70% (0.60–3.50) (p<0.01), but with
normal lymphocyte and eosinophil counts (figure 3). Microbiological
analysis of BAL fluid demonstrated bacterial growth in 35.5% of the
children, but with a pathogen load> 105 colony-forming units (CFU)/mL
only in 10,2% of them. In these cultures, 72.7% of the isolates wereHaemophilus influenzae , 27.3% Streptococcus pneumoniaeand, 9.0% each for Group A β-hemolytic streptococci (GABHS) andMoraxella catarrhalis (figure 4). Coinfection were present in two
isolated, one being positive for Haemophilus influenzae plus
SBEGA and the other for Haemophilus influenzae plus S.
pneumoniae . BAL neutrophilia tended to be higher in children with
bacterial load >103 CFU/mL (figure 5).
Finally, chest CT scan demonstrated the presence of bronchiectasis in
13% of the children, 5.9+2.2 years old, of which one had a positive BAL
culture (>104 CFU/mL) for