ArticleFrontiers in pediatrics2026
Pediatric bronchial Dieulafoy's disease: a biopsy-sparing bronchoscopic approach with selective bronchial artery embolization.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Bronchial Dieulafoy's disease (BDD) is an exceedingly rare vascular malformation in children, characterized by aberrant submucosal arteries prone to life-threatening hemorrhage. The optimal diagnostic and therapeutic pathway remains undefined due to limited pediatric cases. Objective: To evaluate the feasibility and outcomes of a standardized pathway featuring biopsy-sparing bronchoscopy with typical endoscopic signs as triggers for selective bronchial artery embolization (BAE) in pediatric BDD. Methods: This single-center retrospective study analyzed consecutive children (<18 years) with hemoptysis who underwent selective angiography and BAE at the First Affiliated Hospital of Xinxiang Medical University from 2021 onwards. A predefined diagnostic pathway prioritizing airway safety, strict avoidance of biopsy at suspicious lesions, and early progression to BAE was implemented. Patients were classified as confirmed BDD (typical bronchoscopic findings without biopsy, angiographically confirmed) or highly suspected BDD (clinical phenotype consistent, angiographic abnormalities, hemostasis after BAE). Results: Three patients were included (median age 11 years). Two cases demonstrated typical bronchoscopic findings (submucosal elevation without pulsation) with strict biopsy avoidance and were classified as confirmed BDD. One patient bypassed bronchoscopy due to airway instability, classified as highly suspected BDD. All three patients in this cohort showed unilateral bronchial artery abnormalities on selective angiography, and computed tomography angiography (CTA) failed to identify definitive responsible vascular lesions in 100% (3/3) of cases. All patients achieved immediate hemostasis after superselective embolization (microspheres 300-500 μm ± coils). No major complications occurred. During follow-up (3-36 months), no recurrence was observed. Bronchoscopic localization matched angiographic laterality in 2/2 cases where bronchoscopy was performed. Conclusions: A standardized pathway emphasizing biopsy-sparing bronchoscopy and early BAE appears feasible and safe for pediatric BDD management, achieving favorable short-term outcomes even when computed tomography angiography (CTA) is non-localizing or bronchoscopy is bypassed due to clinical instability.
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