Kargl Simon, Frechinger Bettina, Pumberger Wolfgang
Department of Pediatric Surgery, Women's and Children's Hospital Linz, Linz, Austria.
Department of Pediatric Radiology, Women's and Children's Hospital Linz, Linz, Austria.
BMJ Case Rep. 2014 Dec 22;2014:bcr2014207310. doi: 10.1136/bcr-2014-207310.
Chest X-ray in a 17-year-old boy, presenting with haemoptysis, revealed a radiopaque foreign body (FB) in the right lower lobe. There was no history of aspiration. CT located the needle-shaped FB in the right posterobasal lower lobe segment bronchus. In bronchoscopy, the FB turned out to be a pin, of which the radiolucent plastic head was embedded in the peribronchial tissue. Extraction by flexible and rigid bronchoscopy failed; finally, thoracotomy and bronchotomy had to be performed to remove the pin. In delayed diagnosis of a tracheobronchial FB, CT scan is not only necessary to localise the FB but also to depict or rule out secondary pulmonary changes. Nevertheless, radiolucent components of a metallic FB might be invisible even in CT, leading to underestimation of its size and extension. Late diagnosis complicates removal of tracheobronchial foreign bodies and may even necessitate open surgery, including pulmonary resections.
一名17岁咯血男孩的胸部X光片显示右下叶有一个不透射线的异物（FB）。无误吸史。CT显示针状异物位于右下叶后基底段支气管。支气管镜检查发现异物是一枚大头针，其透光的塑料头嵌入支气管周围组织。通过柔性和刚性支气管镜取出失败；最后，不得不进行开胸和支气管切开术以取出大头针。在气管支气管异物的延迟诊断中，CT扫描不仅对于定位异物是必要的，而且对于描绘或排除继发性肺部改变也是必要的。然而，即使在CT上，金属异物的透光部分也可能看不见，导致对其大小和范围的低估。延迟诊断会使气管支气管异物的取出复杂化，甚至可能需要进行包括肺切除在内的开放性手术。
