Wang Lan, Pudasaini Bigyan, Wang Xue-Fen
Department of Pulmonary Medicine, The first affiliated of Zhejiang University School of medicine, Hangzhou, China Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Shanghai.
Medicine (Baltimore). 2016 Aug;95(31):e4076. doi: 10.1097/MD.0000000000004076.
Occult bronchial foreign body can be very difficult to diagnose early in an adult patient without acute symptoms. This report describes a rare case of undetected Chinese medicine "Coptis chinensis" aspiration for 10 long years.
A case was reported that a female patient complained of a 10-year history of productive cough. A battery of tests were given to confirm the diagnosis.
Chest computed tomography (CT) showed extensive bronchiectasis and multiple nodules, along with stenosis of left lower lobar bronchus. An extensive solid lesion with surrounding inflammatory granulation tissue was seen on her first bronchoscopy and biopsy revealed chronic mucosal inflammation. A neglected history of Coptis chinensis regularly kept in-mouth while sleeping for the last 10 years in this patient provided clues for a final diagnosis. Confirmatory diagnosis of bilateral tracheobronchial foreign bodies caused by recurrent inhalation of Coptis chinensis was made by a second bronchoscopy.
This case clearly demonstrates that a precise medical history is often overlooked. A high index of suspicion, a precise medical history, radiographic features of chronic respiratory symptoms not explained by other conditions were keys to diagnosing this case.
隐匿性支气管异物在无急性症状的成年患者中早期很难诊断。本报告描述了一例罕见的长达10年未被发现的中药“黄连”误吸病例。
报告一例女性患者，主诉有10年咳痰病史。进行了一系列检查以确诊。
胸部计算机断层扫描（CT）显示广泛的支气管扩张和多个结节，以及左下叶支气管狭窄。首次支气管镜检查可见广泛的实性病变及周围炎性肉芽组织，活检显示慢性黏膜炎症。该患者过去10年睡觉时经常将黄连含在口中的被忽视病史为最终诊断提供了线索。第二次支气管镜检查确诊为由反复吸入黄连导致的双侧气管支气管异物。
该病例清楚地表明精确的病史常常被忽视。高度的怀疑指数、精确的病史、无法用其他情况解释的慢性呼吸道症状的影像学特征是诊断该病例的关键。
