RESUMO
OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1% of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.
Assuntos
Bronquiolite Viral/diagnóstico , Técnicas de Apoio para a Decisão , Radiografia Torácica/economia , Procedimentos Desnecessários/economia , Bronquiolite Viral/diagnóstico por imagem , Bronquiolite Viral/economia , Colômbia , Análise Custo-Benefício , Custos e Análise de Custo , Árvores de Decisões , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Reembolso de Seguro de Saúde/economia , Pneumonia/economia , Radiografia Torácica/estatística & dados numéricos , Sensibilidade e EspecificidadeRESUMO
Bronchiolitis may be encountered in numerous clinical circumstances. Previous history of smoking, infections, toxic exposure, immunodeficiency, chronic inflammatory disorders or transplantation must be known. CT findings consist in centrilobular micronodules with sharp or ill borders of various density and/or a mosaic attenuation with expiratory air trapping. Tree-in-bud pattern suggest an inflammatory or infectious bronchiolitis. The associated presence of bronchiectasis and bronchiolectasis must be considered. Imaging-pathologic correlations will be presented for inflammatory bronchiolitis (infectious bronchiolitis, hypersensitivity pneumonitis, respiratory bronchiolitis, follicular bronchiolitis, diffuse panbronchiolitis) and fibrosing bronchiolitis (constrictive bronchiolitis, post-infectious bronchiolitis, toxic fume exposure, transplant-related bronchiolitis).
Assuntos
Bronquiolite/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Transplante de Medula Óssea , Bronquiectasia/complicações , Bronquiectasia/diagnóstico por imagem , Bronquiolite/complicações , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Viral/diagnóstico por imagem , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico por imagem , Humanos , Linfoma Folicular/complicaçõesAssuntos
Bronquiolite Viral , Bronquite , Pneumonia , Doença Aguda , Fatores Etários , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bronquiolite Viral/complicações , Bronquiolite Viral/diagnóstico , Bronquiolite Viral/diagnóstico por imagem , Bronquiolite Viral/tratamento farmacológico , Bronquiolite Viral/epidemiologia , Bronquiolite Viral/terapia , Bronquite/diagnóstico , Bronquite/diagnóstico por imagem , Bronquite/tratamento farmacológico , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Hospitalização , Humanos , Lactente , Oxigenoterapia , Pneumonia/diagnóstico , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Pneumonia/terapia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/terapia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/terapia , Prognóstico , Radiografia Torácica , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Fatores de Risco , Fatores de Tempo , Poluição por Fumaça de Tabaco/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
Acute bronchiolitis in infancy appears to be associated with persistence of wheezing or subsequent asthma in later life. Chest imaging techniques have demonstrated persistent structural lung damage such as atelectasis, bronchiectasis, and obliterative bronchiolitis among survivors of the more severe forms of bronchiolitis. In addition, in a significant number of survivors without demonstrable structural damage, pulmonary function studies have revealed a spectrum of disturbances including air-trapping, reduced air flow at low lung volumes, hypoxemia (all indicating disease in the small airways), and bronchial hyperreactivity. However, it has not yet been proven definitively whether the relationship between severe bronchiolitis in infancy and chronic obstructive lung disease is causal or noncausal. Further prospective clinical studies are needed to resolve this question.
Assuntos
Bronquiolite Viral/complicações , Pneumopatias Obstrutivas/etiologia , Doença Aguda , Infecções por Adenovirus Humanos/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Bronquiolite Viral/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Pneumopatias Obstrutivas/diagnóstico por imagem , Masculino , Radiografia , Infecções por Respirovirus/diagnóstico por imagemRESUMO
The clinical experience of 661 children with bronchiolitis is reported in four-years period to gain a better understanding of diagnosis and pathogenesis of bronchiolitis. Upper airways infections, expiratory dyspnea, clear sound by chest percussion, vesicular rales and whistling by chest auscultation, air trapping on the chest radiography were considered as essential data of diagnosis. It was found in 595 patients: expiratory dyspnea, air trapping, vesicular r. and whistling in 85% and whistling only in 15%; hypoxemia in 20% combined with hypercapnic acidosis in 10%; normoxemia in 80% combined with hypocapnia in 54%; hyperlactemia in 64% combined with an increment in the serum of CPK in 50% and of GPT in 30%; virus were cultured in 27%, adenovirus and RSV were identified in 90%. Instead it was found in 66 patients: air trapping but no difficult breath, with normal chest auscultation; crisis of cyanosis or paleness-cyanosis chilly sweat in 80% were motive of admission. The clinical and/or radiological features of "air trapping" were considered as essential symptoms and signs of bronchiolitis. The insufficient systemic perfusion was considered as a frequent occurrence and as cause for sudden respiratory and circulatory emergency.
Assuntos
Bronquiolite Viral/diagnóstico , Bronquiolite Viral/sangue , Bronquiolite Viral/complicações , Bronquiolite Viral/diagnóstico por imagem , Cianose/etiologia , Feminino , Humanos , Lactente , Masculino , RadiografiaRESUMO
X-ray findings in chronic bronchopulmonary diseases in children are presented on the basis of observations made during the last 20 years. Six groups of diseases can be differentiated according to signs and clinical course: Pneumonias with delayed healing, chronic relapsing infiltrations, mucoviscidosis, chronic pleuropneumonia with abscess formation, chronic interstitial processes and chronic infiltrations with bronchiectasis. The typical phenomena and possibilities of differential diagnosis are discussed.
Assuntos
Broncopatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Brônquios/anormalidades , Bronquiectasia/diagnóstico por imagem , Bronquiolite Viral/diagnóstico por imagem , Criança , Pré-Escolar , Doença Crônica , Fibrose Cística/diagnóstico por imagem , Feminino , Hemossiderose/diagnóstico por imagem , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Lactente , Masculino , Sarampo/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Pneumonia Aspirativa/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , Radiografia , Síndrome , Coqueluche/diagnóstico por imagemAssuntos
Angiografia/métodos , Broncopatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pulmão/anormalidades , Pulmão/irrigação sanguínea , Infecções por Adenovirus Humanos/diagnóstico por imagem , Adolescente , Bronquiectasia/diagnóstico por imagem , Bronquiolite Viral/diagnóstico por imagem , Bronquite/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Hemossiderose/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Técnica de SubtraçãoRESUMO
Pulmonary sequestration is a rare congenital malformation. It is characterized by an abnormal arterial supply and venous drainage and a part of the lung which is not taking part in ventilation. Asymptomatic cases have been reported, but 37% of intralobar and 60% of extralobar sequesters became symptomatic before the age of ten years and need to be removed surgically. In this article one case-report illustrates the clinical course described in most cases whilst the other describes a patient in which the course mimicked an 'untreatable' bronchiolitis.
Assuntos
Sequestro Broncopulmonar/diagnóstico por imagem , Angiografia , Bronquiolite Viral/diagnóstico por imagem , Broncografia , Sequestro Broncopulmonar/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , PneumonectomiaRESUMO
We reviewed our experience with 41 children hospitalized from 1974 to 1978 for adenovirus (ADV) bronchiolitis. Thirty-two patients (78 percent) were native Indians between four and 12 months old. In 18 of the 41 patients (43.9 percent) acute complications developed. The five fatal cases (12.2 percent) were confined to native children. The initial chest roentgenograms showed lobar consolidation in 35 patients (85.4 percent). Atelectasis developed in five (12.2 percent) during hospitalization. Sixteen of 25 patients (64 percent) with adequate radiologic follow-up examination had subsequent pneumonias or showed residual chronic changes. The reasons for the predilection of ADV bronchiolitis in native Indian children and the precise effect on subsequent airway function in survivors are unknown and require further study. We emphasize the importance of ADV as a cause of bronchiolitis in native Indian children. Furthermore, this report focuses attention on the contribution of this disease to the spectrum of chronic pulmonary disorders in the pediatric group.
Assuntos
Infecções por Adenoviridae/epidemiologia , Infecções por Adenovirus Humanos/epidemiologia , Bronquiolite Viral/epidemiologia , Infecções por Adenovirus Humanos/complicações , Infecções por Adenovirus Humanos/diagnóstico por imagem , Adolescente , Adulto , Bronquiolite Viral/complicações , Bronquiolite Viral/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Indígenas Norte-Americanos , Masculino , Manitoba , Radiografia , Estudos RetrospectivosRESUMO
A clinical series of 40 consecutive patients with chronic unilateral hyperlucent lung was analysed. Swyer-James (MacLeod) syndrome turned out to be the most common diagnosis (18 patients, 45%). Other causes were localized emphysema (8 patients, 20%), congenital hypoplastic pulmonary artery (4 patients, 10%), previous massive pulmonary embolism (4 patients, 10%), bronchial carcinoma (3 patients, 7.5%), sequelae of radiation therapy (2 patients, 5%) and benign intrabronchial neoplasm (1 patient, 2.5%). The reduction of pulmonary vasculature was scored (0-9). The most extensive reduction was found in patients with Swyer-James syndrome (mean 5.8), whereas patients with bronchial cancer had the smallest changes (mean 3.0).
Assuntos
Pneumopatias/diagnóstico por imagem , Circulação Pulmonar , Adenoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Neoplasias Brônquicas/diagnóstico por imagem , Bronquiolite Viral/diagnóstico por imagem , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Embolia Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , RadiografiaRESUMO
Thirteen infants and children with adenovirus type 7 infection proved by virus isolation are described. High fever, cough and dyspnea were the most frequent findings; in infants under 1 year of age wheezing was common. Four patients required artificial ventilation. Lobar collapse, consolidation and hyperinflation were frequent radiologic findings. None of the symptoms responded to antibiotic therapy or bronchodilator drugs. Three patients died (mortality rate of 23%). Pathologic findings were compatible with adenovirus type 7 pneumonia, and were characterized by a necrotizing bronchitis and bronchiolitis, patchy alveolar fibrinopurulent exudate and hyaline membrane formation. Some intra-alveolar epithelial cells showed strikingly abnormal nuclei and rare typical halo-outlined intranuclear inclusions were seen. Only one of eight survivors had evidence of significant chronic chest disease.