Granulomatous hyperinflammatory state induced by dupilumab treatment for eosinophilic esophagitis.

We present the first case of a dupilumab-induced hyperinflammatory state in the setting of underlying eosinophilic esophagitis characterized by multisystem granulomatous inflammation. Although clinical trial data and subsequent real-world experience support dupilumab as a highly effective therapy for eosinophilic esophagitis, close monitoring for development of adverse symptoms following initiation remains paramount.

Advanced Diagnostic and Therapeutic Bronchoscopy in Pediatrics.

Advanced diagnostic and therapeutic flexible bronchoscopy in children is a rapidly evolving field. Recent advances in technology and awareness of indications, risks, and benefits by pediatric providers have greatly increased the use of advanced techniques in children. This review highlights advanced diagnostic procedures including assessment of endobronchial lesions, mediastinal/hilar masses, and peripheral lung nodules as well as therapeutic techniques for restoring airway lumen patency, managing persistent air leaks, and treating tracheoesophageal fistulas in children as well as the potential to spare these patients more invasive procedures.

Exposures and coexisting conditions in pediatric nodular tracheobronchitis.

Background: The aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy.

Methods: We conducted a single-center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023.

Results: Common coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%).

Consensus on intake questionnaire data elements in the development of an aerodigestive registry.

Objective: To define the essential elements of the intake questionnaire that will be a part of a larger multicenter registry for aerodigestive patients.

Methods: A modified Delphi method was utilized to obtain consensus on the data elements that should warrant inclusion in the final research database. Patient questionnaires from the eight participating institutions were reviewed and individual elements were aggregated into 14 categories.

Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States.

Introduction: Advanced diagnostic bronchoscopy includes endobronchial ultrasound (EBUS) guided transbronchial lung and lymph node biopsies, CT navigation and robotic bronchoscopy. Interventional bronchoscopy refers to procedures performed for therapeutic purposes such as balloon dilation of the airway, tissue debulking, cryotherapy, removal of foreign bodies and insertion of endobronchial valves [1]. For adult patients, these procedures are standard of care [2, 3].

Dynamic airway computed tomography and flexible bronchoscopy for diagnosis of tracheomalacia in children: A comparison study.

Introduction: Tracheomalacia (TM) is an important cause of respiratory morbidity. Dynamic flexible bronchoscopy is considered the gold standard for diagnosis. Dynamic airway computed tomography (DACT) is a low radiation, noninvasive diagnostic tool utilizing images obtained continuously over several respiratory cycles.

Diagnostic yield of endobronchial ultrasound and virtual CT navigational bronchoscopy for biopsy of pulmonary nodules, mediastinal lymph nodes, and thoracic tumors in children.

Objective: Endobronchial ultrasound-guided transbronchial biopsy and needle aspiration (EBUS-TBB/EBUS-TBNA) are first line investigative modalities for lung and mediastinal pathology in adults. We aimed to characterize and assess the diagnostic yield of EBUS and virtual CT navigation guided biopsies in children.

Study Design: This single center, retrospective cohort study included patients who underwent radial or linear EBUS procedures (+/- CT navigation) for biopsy of mediastinal lymph nodes, tumors, and pulmonary nodules.

Eosinophilic plastic bronchitis: Case series and review of the literature.

Plastic bronchitis is a term used to describe group of life-threatening disorders characterized by the presence of large obstructing casts in the airways. Eosinophilic plastic bronchitis is a subtype of plastic bronchitis that occurs mainly in children and has not been well-described in the literature. Patients may have a history of asthma or atopy, but many do not.

A multicenter study analyzing the impact of pre-existing comorbidities on laryngotracheal reconstruction (LTR) outcomes.

Introduction: Comorbidities such as chronic lung disease and gastroesophageal reflux (GERD), prematurity, and numerous other conditions may impact the success of LTR. Single-center studies are limited in terms of patient numbers and may be underpowered.

Objectives: To analyze the impact of specific comorbidities on the operation-specific and overall surgical success of LTR in a large multicenter cohort and validate a predictive model for surgical success.

Rare airway tumor in a previously healthy adolescent successfully treated with endoscopic resection and oral propranolol.

Airway tumors are rare in children. Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign vascular tumor usually found on the skin or in the oral cavity. Rarely, these lesions occur in the airway and cause significant hemoptysis.

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.

Objective: To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention.

Design: Mixed-methods study.

Setting: Tertiary-care pediatric intensive care unit (PICU).

Subcutaneous Implantation of Hepatocellular Carcinoma in a Dog.

A 13-year-old male neutered Cocker Spaniel mixed-breed dog developed a subcutaneous mass 2 years after undergoing surgery to remove a hepatocellular carcinoma. An approximately 4 × 3 cm subcutaneous mass was found on the ventral abdomen at the cranial end of the abdominal incision from the previous surgery. The subcutaneous mass was surgically removed and histopathological examination determined that it was an implantation of the previously excised hepatocellular carcinoma.

Digital Cytology.

Microscopic evaluation of cytologic specimens can provide rapid diagnostic information and aid in formulating diagnostic and treatment plans. The primary benefit of cytologic evaluation is the rapid collection, processing, and evaluation of samples. However, physical transport of glass slides and body fluids to a diagnostic laboratory takes time and can negatively affect patient management.

Hemosiderin-Laden Macrophages in Bronchoalveolar Lavage Samples of Children with Bronchopulmonary Dysplasia.

Objectives: To evaluate the prevalence of hemosiderin-laden macrophages in children with bronchopulmonary dysplasia (BPD) and assess for an association between hemosiderin-laden macrophages and pulmonary arterial hypertension.

Study Design: Retrospective case-control study of infants and children with and without BPD who underwent bronchoscopy with bronchoalveolar lavage (BAL) the at Children's Hospital of Philadelphia between 2012 and 2021.

Results: BAL from 205 children with BPD and 106 controls without BPD matched for tracheostomy, infection, and age were reviewed for hemosiderin-laden macrophages.

Utility of Thyroid Function Testing in the Inpatient Setting.

Objective: Previous studies have reported a low value of ordering inpatient thyroid function tests (TFTs), with few changes in clinical management resulting from these tests. This study was designed to evaluate how often testing the thyroid function during hospitalization leads to medication initiation or adjustment and to determine whether the frequency of medication initiation or adjustment differs based on the indication for testing.

Methods: This is a retrospective observational study of 2278 patients who underwent TFTs tested while admitted to an academic hospital during a 5-month period.

Comparison of tracheal aspirate and bronchoalveolar lavage samples in the microbiological diagnosis of lower respiratory tract infection in pediatric patients.

Background: Bacterial cultures from tracheal aspirates (TA) and bronchoalveolar lavage (BAL) specimens can be used to assess patients with artificial airways for lower respiratory tract infections (LRTI). TA collection may be advantageous in situations of limited resources or critical illness. Literature comparing these diagnostic modalities in pediatric populations is scarce.