Management of bilateral congenital bronchial stenosis in an infant Juan L. Antón-Pacheco a, ⁎ , Lorenzo Galletti b , Daniel Cabezalí a , Carmen Luna a , Gabino González de Orbe c , Manuel Sánchez-Solis de Querol d a Pediatric Airway Unit and Division of Pediatric Surgery, Madrid, Spain b Pediatric Institute of the Heart, Madrid, Spain c Department of Radiology, University Hospital “12 de Octubre”, Madrid, Spain d Division of Pediatrics, University Hospital “Virgen de la Arrixaca”, Murcia, Spain Index words: Bronchial stenosis; Congenital airway anomalies; Tracheal stent; Pediatric bronchoscopy Abstract Congenital bronchial stenosis is a very uncommon condition in children. A full-term neonate showed severe respiratory distress soon after birth. Bronchoscopy and spiral computed tomography with multiplanar reconstruction disclosed a short stenosis of the left main bronchus, next to the carina, and another stenosis in the intermediate bronchus with air trapping in the right middle and lower lobes. The child underwent resection and reconstruction of the left main bronchus, and right middle and lower lobectomies after a failed attempt of bronchoscopic dilatation of the intermediate bronchus. A temporary silicon tracheal stent was necessary to achieve permanent extubation. The patient was discharged in good condition without any oxygen dependency and remains asymptomatic 1 year after surgery. Management of children with airway stenosis is complex, and surgeons involved in it should be familiar with multiple surgical and endoscopic techniques. A team approach in a referral center is the best option to achieve an optimal result. © 2007 Elsevier Inc. All rights reserved. Bronchial stenosis is a very rare condition in children. Acquired stenosis in neonates, because of selective intuba- tion of the right main bronchus, is probably more frequent than congenital stenosis of the major bronchi. Surgical repair of the stenotic bronchus is a highly demanding procedure because of the small size of the airway. 1. Case report A full-term neonate, delivered by cesarean section, showed severe respiratory distress immediately after birth. The patient was initially intubated and ventilated for 5 days, and then, continuous positive airflow pressure (CPAP) was instituted. Chest x-ray disclosed air trapping in the inferior right lower lobe and atelectasis in the left upper lobe. A flexible bronchoscopy showed a severe juxtacarinal left main bronchus stenosis not allowing the 2-mm bronchoscope to get through it (Fig. 1A). In the right bronchial divisions, another tight stenosis was identified in the intermediate bronchus. Spiral chest computed tomography (CT) with multiplanar reconstruction (MPR) confirmed the broncho- scopic findings: the left main bronchus stenosis was 3 to 4 mm long, with a diameter of 0.8 to 1 mm, and the length of the intermediate bronchus stenosis was 2 to 3 mm, producing middle and lower lobe emphysema (Fig. 2). The patient was transferred to our unit on day 68 of life for surgical management. We decided to deal with the left main bronchus ⁎ Corresponding author. c/Vallehermoso 20, 7°A izda, Madrid 28015, Spain. Tel.: +34 91 4451516; fax: +34 91 3908375. E-mail address: janton.hdoc@salud.madrid.org (J.L. Antón-Pacheco). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2007.08.043 Journal of Pediatric Surgery (2007) 42, E1–E3