Wineski Robert E, Panico Emma C, Bailey Luke N, Cardenas Agustin M, Grayson Jessica W, Wiatrak Brian J
Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center.
Department of Radiology, Children's of Alabama Hospital, Birmingham, AL.
Radiol Case Rep. 2020 Sep 22;15(11):2391-2395. doi: 10.1016/j.radcr.2020.09.031. eCollection 2020 Nov.
Diagnosis of an airway foreign body in the setting of an unwitnessed aspiration event remains a challenge for physicians in the emergency setting. We describe a case of a 2-year-old male who presented to the emergency department with atypical symptoms resulting from ingestion and aspiration of a large, flat sticker. The airway foreign body remained in place for over 24 hours despite obtaining appropriate airway imaging, and the object was later removed without complication via rigid bronchoscopy in the operating room. Further review of this case and the current literature highlighted multiple lessons. Initial evaluations should combine a rigorous history and physical with strict guidelines on usage of multiple imaging modalities (eg, plain radiographs and CT). Imaging should be obtained with the patient devoid of all obstructive materials in multiple positions (eg, upright, supine, lateral) in order to maximize the physician's ability to positively diagnose airway foreign bodies prior to definitive treatment with rigid bronchoscopy.
在未目击的误吸事件中诊断气道异物，对急诊科医生来说仍是一项挑战。我们描述了一例2岁男性病例，该患儿因吞食并误吸一张大的扁平贴纸而出现非典型症状，前来急诊科就诊。尽管进行了适当的气道成像检查，但气道异物仍存留超过24小时，随后在手术室通过硬质支气管镜顺利取出，未出现并发症。对该病例及当前文献的进一步回顾凸显了多个经验教训。初始评估应将严谨的病史和体格检查与关于多种成像方式（如胸部X线平片和CT）使用的严格指南相结合。成像检查时患者应处于多个体位（如直立位、仰卧位、侧卧位）且无任何阻塞性物质，以便在通过硬质支气管镜进行确定性治疗之前，最大限度地提高医生确诊气道异物的能力。
