Abstract Introduction Bronchial webs are fibrous membranes in the airway lumen. These are rare and can be congenital or acquired. Congenital lesions are formed from abnormal bronchus development while acquired webs may result from trauma, infection, inflammation, or immune changes. Bronchial webs are frequently underdiagnosed as presentation can be nonspecific. Medical management with steroids is common, however only a few pediatric cases necessitating interventional bronchoscopy procedures are reported. We present a case of a 5-year-old female with bronchial webs who underwent balloon dilation. Case A 5-year-old female with Moebius syndrome, anoxic brain injury, asthma, tracheostomy and ventilator dependence, eosinophilic esophagitis, g-tube dependence and hypotonia, presented as a transfer to our institution for medical optimization prior to long-term care facility placement. This patient had a history of multiple prolonged hospitalizations for respiratory failure. A recent admission in the setting of Adenovirus infection and pneumonia required Extracorporeal Membrane Oxygenation(ECMO) cannulation at an outside facility along with high ventilator settings, prolonged steroid courses, and continuous albuterol for persistent wheezing. Following transfer, we performed a flexible bronchoscopy, which showed multiple thin, translucent, intraluminal bronchial membranes with central pin-point perforations from the 6th to 8th generation bronchi in the right upper lobe, right lower lobe, and left lower lobe, consistent with bronchial webs. Bronchoalveolar Lavage cultures grew multidrug resistant pseudomonas and achromobacter. Computed Tomography (CT) chest showed severe bilateral bronchiectasis in the lower lobes likely post obstructive in nature. These webs attributed to her obstructive pathology and refractory response to asthma management. Interventional pulmonology performed balloon dilation of bronchial webs in the right lower and right upper lobes using Fogarty 5 Fr balloon catheters, resulting in successful dilation. Multiple subsequent bronchoscopies were performed that confirmed patency. Clinical status improved after dilation and prolonged antibiotics. However, she continued to require significant respiratory support due to severe bronchiectasis and inflammation. She later developed multiple complications including pneumomediastinum. After a protracted multidisciplinary effort to improve her lung disease, shared decision was made with family to redirected goals towards palliative care. Discussion Bronchial webs should be considered in patients with nonspecific cough, refractory asthma, obstructive lung disease following infection, trauma, foreign body aspiration or inflammation. Diagnosis is made via direct visualization through flexible bronchoscopy. Management may vary with cause however interventional bronchoscopy techniques such as balloon dilation may be utilized in pediatrics to restore airway patency. If left untreated, may lead to post obstructive atelectasis, hyperinflation, bronchiectasis, and permanent lung damage. This abstract is funded by: None
Mandal et al. (Fri,) studied this question.