home my page contact us sitemap
    Related Site
APAPARI 2018
APAPARI 2017
30th Anniversary Congress of KAPARD 2017
CIPP 2017
EAACI 2017
About the Apapari News Membership Resources Web Links
    For Patients
    For Professionals
    Case Discussion
    Photo Gallery
    Data
    Hot Issue

5/F, Pulmonary artery sling with tracheal ring / recurrent wheezing, cough for 5 years(aggravation; 2 days ago)
Chief complaint
or Title
Pulmonary artery sling with tracheal ring / recurrent wheezing, cough for 5 years(aggravation; 2 days ago)
Difficulty For student/For resident
Seung Kyu Lee, MD, Young Ho Kim, MD, Hae Ran Lee, MD[drran@hallym.or.kr],
2005.03.21
Department of Pediatrics, the Kang-Dong Sacred Heart Hospital, College of Medicine, Hallym University. Seoul, Korea
* History
Present illness; She was already diagnosed as a congenital laryngomalacia in an ENT department of other general hospital by laryngoscopy a few years ago. For a few years, she frequently visited to our hospital because of acute bronchiolitis and infantile asthma and was admitted. 2 days ago, dyspnea and cough developed and aggravated, so she visited to the hospital again and was admitted.
Past history
birth history ; IBW- 2.86 kg , normal full-term spontaneous vaginal delivery

Amission history

at age of 6 month  
cough, grunting, dyspnea à admission (acute bronchiloitis)
HD(hospital day) #2 cyanotic change, dyspnea aggravation àmove to ICU, intensive management.
HD #5 fever developed, cough, sputum aggravation à chest CT(HRCT) done
           Chest CT : no specific finding on lung parenchyma ,diffuse narrowing of trachea diameter            
HD #8 general condition improved à move to general ward
HD #15 Discharge
    
   at age of 10 month
cough, dyspnea, noisy breath sound à admission (acute bronchiloitis)
HD #1 dyspnea aggravation, persistent wheezing and stridor à move to  ICU
HD #5 dyspnea and wheezing decreased, move to general ward, but stridor  persisted      
HD #10 symptoms improved, discharged
OPD(out-patient department) follow-up

at age of 22 month
    dyspnea, cough, sputum àER visit à admission to ICU (infantile asthma)
    management; Nebulizer(salbutamol, budesonide) , IV steroid, IV aminophylline,
O2 inhalation(2L/min)
    HD #4 dyspnea subsided and SaO2 98% at room air à move to general ward
    HD #8  no dyspnea, but stridor persisted
            Oral aminophylline
    HD #11 symptoms improved, discharged
OPD follow-up

   at age of 28 month
    dyspnea à admission
    HD #6 dyspnea improved, but wheezing and stridor persisted
    HD #9 symptoms improved, discharged
OPD follow-up
Vaccination history : all done by schedule
Family history : no remarkable finding
* R.O.S.& P/Ex
Review of system
fever (+), cough/sputum/rhinorrhea (+/+/-) , vomiting/dirrahea (-/-)
dyspnea/cyanosis (+/-) , poor oral intake

Physical examination
Vital sign : PR 128/min   RR 34/min   BT 37.8?
G/A acutely ill-looking appearance, difficulty to breath
HEENT  not anemic conjunctiva , anicteric sclerae
           peritonsillar hypertrophy (++/++) with throat injection
           not dehydrated tongue & oral mucosa
           not palpable neck mass
Chest    regular heart beat without murmur
           coarse breathing sound with wheezing, inspiratory stridor
           symmetric expansion with severe retraction
Abdomen soft and flat , hyperactive bowel sound
Back & Extremities  no specific findings
* Lab




CBCElectrolyteRoutine chemistry
WBC6,510(62.6/25.4)Na148 mEg/LBUN/Cr10.4/0.4 mg/dl
Hb13.2 g/dlK4.6 mEg/LProtein7.5 g/dl
Hematocrit38.4 %Cl106 mEg/LAlbumine5.0 g/dl
Platelet293,000 /uLAST/ALT35/20 IU/L
Ca/P9.7/4.3 mg/dl
* Clinical Course
HD#1; severe dyspnea and cough, SaO2 95%, chest retraction à epinephrine subcutaneous injection, O2 3L inhalation, Salbutamol and budesonide inhalation via nebulizer, Aminophylline I.V. , Steroid (methyl prednisolone) I.V.
HD#6; dyspnea improved ,severe cough and chest wall retraction, wheezing and stridor  
HD #11; cough and wheezing decreased
         Aminophylline I.V à change to  P.O. medication
HD #16; stridor, chest wall retraction persisted
         Chest CT & Bronchoscopy 3D CT done à the left pulmonary artery comes out from an aberrant origination in the right pulmonary artery, and then it goes through   between main trachea and  left bronchus so it compresses air-way. The trachea is narrowed through long segment and it has no membranous portion, so it is called 'tracheal ring'.
HD #17; symptoms improved, discharged
      
*Her respiratory symptoms has been more improved than before ,so we have not decided to do operation for pulmonary artery sling and tracheal ring. Nowadays we have observed her symptoms.


* If you click the image you able to see original image











[Case list]   
* Comment
  2017.07.07  
Copyright 2004 by APAPARI. All right Reserved.