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Original Research: SIGNS AND SYMPTOMS OF CHEST DISEASES |

Bronchoscopic and High-Resolution CT Scan Findings in Children With Chronic Wet CoughBronchoscopy and CT Scan Findings in Children

Konstantinos Douros, MD; Efthymia Alexopoulou, MD, PhD; Aggeliki Nicopoulou, MD; Michael B. Anthracopoulos, MD, PhD; Andrew Fretzayas, MD, PhD; Panayiotis Yiallouros, MD, PhD; Polixeni Nicolaidou, MD, PhD; Kostas N. Priftis, MD, PhD
Author and Funding Information

From the Third Department of Paediatrics (Drs Douros, Fretzayas, and Nicolaidou), and the Second Department of Radiology (Drs Alexopoulou and Nicopoulou), “Attikon” Hospital, University of Athens School of Medicine, Athens; the Respiratory Unit (Dr Anthracopoulos), Department of Paediatrics, Medical School of the University of Patras, Rion-Patras; the Cyprus International Institute for Environmental and Public Health in association with Harvard School Public Health (Dr Yiallouros), Cyprus University of Technology, Limassol, Cyprus; and the Department of Allergy-Pneumonology (Dr Priftis), Penteli Children’s Hospital, P. Penteli, Greece.

Correspondence to: Konstantinos Douros, MD, 3rd Department of Paediatrics, “Attikon” Hospital, 1 Rimini Str, Chaidari 12464, Greece; e-mail: costasdouros@gmail.com


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

For editorial comment see page 278

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):317-323. doi:10.1378/chest.10-3050
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Background:  Chronic wet cough strongly suggests endobronchial infection, which, if left untreated, may progress to established bronchiectasis. Our aim was to compare the effectiveness of chest high-resolution CT (HRCT) scanning and flexible bronchoscopy (FB) in detecting airway abnormalities in children with chronic wet cough and to explore the association between radiologic and bronchoscopic/BAL findings.

Methods:  We retrospectively evaluated a selected population of 93 children (0.6-16.4 years) with wet cough for > 6 weeks who were referred to a specialized center and deemed unlikely to have asthma. All patients were submitted to hematologic investigations, chest radiographs (CXRs), HRCT scanning, and FB/BAL. HRCT scans were scored with the Bhalla method, and bronchoscopic findings of bronchitis were grouped into five grades of severity.

Results:  Positive HRCT scan findings were present in 70 (75.2%) patients (P = .76). A positive correlation was found between Bhalla score and duration of cough (ρ = 0.23, P = .028). FB/BAL was superior to HRCT scan in detecting abnormalities (P < .001). The Bhalla score correlated positively with type III (OR, 5.44; 95% CI, 1.92-15.40; P = .001) and type IV (OR, 8.91; 95% CI, 2.53-15.42; P = .001) bronchoscopic lesions; it also correlated positively with the percentage of neutrophils in the BAL (ρ = 0.23, P = .036).

Conclusions:  HRCT scanning detected airway wall thickening and bronchiectasis, and the severity of the findings correlated positively with the length of clinical symptoms and the intensity of neutrophilic inflammation in the airways. However, HRCT scanning was less sensitive than FB/BAL in detecting airway abnormalities. The two modalities should be considered complementary in the evaluation of prolonged wet cough.

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