Li Xin-Yu, Hou Hai-Jia, Dai Bing, Tan Wei, Zhao Hong-Wen
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
World J Clin Cases. 2021 Nov 16;9(32):9935-9941. doi: 10.12998/wjcc.v9.i32.9935.
Foreign body aspiration mainly occurs in children, which can cause a severe concurrent syndrome and even death without timely treatment. As a rare foreign body, aspiration of lime is seldom reported, and most cases involve a small amount of hydrated lime. Although the symptoms are usually severe, the prognosis is good after suitable treatment. Experience of treatment for lime aspiration is lacking, and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.
We report an adult with a large amount of burnt lime aspiration. Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital, he suffered several severe complications, including complete occlusion of the right primary bronchus, aeropleura, aerodermectasia, pneumomediastinum, secondary infection and hypoxemia at 4 d after injury. After transferring to our department, bronchoscopy was immediately carried out to clear the lime in the major airway, using foreign body forceps, biopsy forceps, puncture needle, and hairbrush. The patient's condition recovered rapidly and at 3-months' follow-up, he demonstrated good recovery of the bronchus and lung parenchyma.
After mass lime aspiration, flexible fiberoptic bronchoscopy is suggested as early as possible, using clamping, flushing or cryotherapy.
异物吸入主要发生于儿童,若不及时治疗可导致严重的并发综合征甚至死亡。作为一种罕见的异物,石灰吸入鲜有报道,且大多数病例涉及少量熟石灰。尽管症状通常较为严重,但经过适当治疗后预后良好。目前缺乏石灰吸入的治疗经验,本报告为使用支气管镜治疗大量生石灰吸入提供了新的证据。
我们报告一名成年患者大量吸入生石灰。由于当地医院对气管和支气管内吸入的石灰清除延迟,他在受伤后4天出现了多种严重并发症,包括右主支气管完全阻塞、气胸、皮下气肿、纵隔气肿、继发感染和低氧血症。转至我科后,立即使用异物钳、活检钳、穿刺针和毛刷通过支气管镜清除主气道内的石灰。患者病情迅速恢复,在3个月的随访中,支气管和肺实质恢复良好。
大量石灰吸入后,建议尽早使用钳夹、冲洗或冷冻疗法进行可弯曲纤维支气管镜检查。