Bronchial adenoma in childhood.

Case Report D.F., a 6-year-old girl, came to the Children's Hospital, Birmingham, in February, 1953, because of seven attacks of 'left basal pneumonia', the last being in July, 1952. The first illness had been treated in Malaya in 1951 and had responded to a course of streptomycin and sulphonamides. She was a well built, somewhat pallid child with no symptoms. Finger clubbing was absent; the trachea was central and the apex beat in the fifth intercostal space in the mid-clavicular line. There was an area of impaired percussion note and diminished air entry at the left base. The Mantoux test (1 in 1,000) was negative. Radiography showed a partial collapse of the left lower lobe with honeycomb air shadows in this area; on bronchographic examination the basal segments of the left lower lobe could not be filled and the lower lobe bronchus, just below the apical branch, had a pointed termination suggestive of intra-bronchial obstruction; the apical segment of the lower lobe was large and appeared healthy (Fig. 1). Sputum culture produced a growth of penicillinsensitive Streptococcus viridans, pneumococci and Staphylococcus aureus. The pre-operative diagnosis was bronchiectasis with segmental collapse due to bronchial occlusion and it was decided to perform resection of the basal segments of the left lower lobe, with conservation of the apical segment. Operation on March 11 was performed under thiopentone, tubo-curarine and endotracheal nitrous oxide and oxygen anaesthesia. With the child in the lateral position, the left chest was opened through the bed of the resected sixth rib. Adhesions between the partially collapsed basal segments of the lower lobe, the diaphragm and the chest wall were divided. The fissure was dissected and the artery and vein to the basal segments were divided and ligated. The bronchus was cleared and clamped low down; it was then opened and a smooth firm, yellowish nodule, the size of a pea, was seen occluding the lumen. The tumour was attached by a broad pedicle and was removed together with the portion of bronchus to which it was attached. The bronchial stump was trimmed to the level of the apical segmental bronchus, closed with interrupted No. 80 thread sutures and covered with pleura. Apical and basal intercostal tube drains were inserted and the chest closed. The post-operative course was uneventful; the remainder of the left lung remained well expanded and the child was discharged two weeks after operation. The child has remained well since operation. Radiographic examination 10 months' later showed that the apical segment of the lower lobe was well expanded and bronchoscopy excluded recurrence.