Matsuse H, Shimoda T, Kawano T, Fukushima C, Mitsuta K, Obase Y, Tomari S, Saeki S, Kohno S
The Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Respiration. 2001;68(1):103-5. doi: 10.1159/000050473.
A 56-year-old Japanese male with persistent cough, stridor and diffuse wheezing for 6 months had obstructive pulmonary dysfunction and airway hyperresponsiveness (AHR) to inhaled methacholine. Because of a poor response to glucocorticoid therapy and neutrophilia in the peripheral blood and sputum, chest computed tomography was performed and a plate-like tumor in the truncus intermedius was identified. Fiberoptic bronchoscopy demonstrated a plate-like green-colored tumor firmly impacted into the truncus intermedius and diffuse inflammatory changes spreading to both main bronchi. A piece of 'kombu' (Japanese kelp) was successfully removed by fiberoptic bronchoscopy under general anesthesia. Pulmonary function and methacholine inhalation tests became normal after the removal of the foreign body. In this case, it is suggested that asthma-like symptoms were due to localized airflow limitation in the right bronchus as well as to AHR associated with diffuse airway neutrophilic inflammation.
一名56岁日本男性，持续咳嗽、喘鸣及弥漫性哮鸣6个月，存在阻塞性肺功能障碍及对吸入乙酰甲胆碱的气道高反应性（AHR）。由于对糖皮质激素治疗反应不佳且外周血及痰液中存在中性粒细胞增多，遂行胸部计算机断层扫描，发现中间段支气管有一板状肿瘤。纤维支气管镜检查显示一板状绿色肿瘤牢固嵌顿于中间段支气管，并伴有蔓延至双侧主支气管的弥漫性炎症改变。在全身麻醉下通过纤维支气管镜成功取出一块“昆布”（海带）。异物取出后肺功能及乙酰甲胆碱吸入试验恢复正常。在该病例中，提示哮喘样症状是由于右支气管局部气流受限以及与弥漫性气道中性粒细胞炎症相关的AHR所致。
