Can bronchoscopic airway anatomy be an indicator of autism?

Abstract

Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated "doublets") in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited the presence of initial normal anatomy in upper airway followed by doublets in the lower airway. In contrast, the normal branching pattern was noted in all the remaining 410 subjects who did not have a diagnosis of autism/ASD. We propose that the presence of doublets might be an objective, reliable, and valid biologic marker of autism/ASD.

Fig. 1

Plates A (from a control subject) and B (ASD subject) were extracted from bronchoscopies of a right upper lobe. Plate A shows a picture of a normal lobe with three single, individual take-offs. Note that the two bottom branches are not doublets because the branches are not parallel to each other, and branch at different angles. Plate B shows three pairs of doublets, one pair in each segment. Both branches in each pair are parallel to that of the other, and thus appear to proceed to the same destination

Fig. 2

Plates A (control subject) and B (ASD subject). Plate A illustrates a normal upper segment. The lower segment shows a fairly large branch to the right and a smaller branch to the left. Because they are highly asymmetric and differ greatly in size and shape, and branch at different angles, they are not doublets. Plate B contains multiple doublets. The lower segment divides into two branches. Moreover, doublets appear in each branch

Fig. 3

Both Plates A (control subject) and B (ASD subject) represent the left upper lobe. Plate A demonstrates slight compression of the inferior segmental bronchus, but otherwise the anatomy is normal. Plate B representing upper segmental bronchus demonstrates a clear doublet in the superior aspect with a pattern similar to Figs. 1 and 2 of ASD subjects. The inferior doublet contains a small amount of mucus that semi-occludes the lumen of the inferior lateral space

Fig. 4

Plates A (control subject) and B (ASD subject) represent the left lower lobe. Although the lower segmental branch in Plate A may appear to be a doublet, it is not a doublet: the branches are not symmetric, one branch appears to be larger than the other, and their angles are different. In Plate B, clear doublets are noted in the left lower lobe