ABSTRACT

Chronic lung disease in childhood is defined as the presence of respiratory symptoms with continuous evolution for 3 months, or recurrent evolution with six or more relapses in a 12 month period. Gastroesophageal reflux is a major cause of pulmonary illness and chronic cough in childhood. The presence of a hiatal hernia, which is mainly manifested by vomit, favors development of symptoms. There is a national consensus for the management of patients with chronic lung disease, and its recommendations are of the upmost importance to opportunely establish the diagnosis and prevent complications. In this communication, the case of a 3 years old male patient with chronic lung disease caused by a hiatal hernia is presented. The patient began at infancy with chronic cough, without clinical data suggestive of gastroesophageal reflux and even with normal barium swallow radiographs. Due to the presence of growth delay, a digestive endoscopy was performed and a large hiatal hernia was observed. A bronchoscopic procedure demonstrated lipophages in the bronchoalveolar lavage, suggesting the existence of gastroesophageal reflux. The patient was submitted to fundoplication, after which symptomatic improvement and resolution of the pulmonary involvement were observed. This case illustrates the importance of a systematized approach in order to establish a timely diagnosis and hence to avoid growth and development delay in these patients.

KEYWORDS

Chronic lung disease in childhood, hiatal hernia, gastroesophageal reflux, fundoplication.

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