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气道内的玻璃:一项支气管镜检查的挑战。

Glass in the Airways: A Bronchoscopic Challenge.

作者信息

Doppalapudi Sai, Fortuzi Ked, Qasim Abeer, Yordanka Diaz Saez, Khaja Misbahuddin

机构信息

Pulmonary and Critical Care Medicine, BronxCare Hospital, New York City, USA.

Pulmonary Medicine, BronxCare Hospital, New York City, USA.

出版信息

Cureus. 2024 Jan 31;16(1):e53344. doi: 10.7759/cureus.53344. eCollection 2024 Jan.

DOI:10.7759/cureus.53344
PMID:38435889
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10907552/
Abstract

Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever. These varied presentations, coupled with the fact that many other medical conditions can mimic the respiratory symptoms seen in FBA, make diagnosis challenging. A high index of suspicion is often required, especially in cases where the patient's history does not clearly point toward aspiration. Immediate management focuses on supporting the airway, which is crucial given the potential for severe obstruction. Radiographic imaging plays a key role in localizing the foreign body, which is vital for planning its removal. Bronchoscopy, particularly flexible bronchoscopy, is the cornerstone of both diagnosis and treatment. This technique allows for direct visualization of the airways, localization of the foreign body, and its subsequent removal. This is crucial to avoid long-term complications, which can arise if the foreign body is not promptly and effectively removed. In this case report, we present a 64-year-old female patient who was found to have a foreign object positioned in the right lower lobe of the lungs that was removed via flexible bronchoscopy.

摘要

成人异物吸入(FBA)确实是一个重大的医学问题,尽管其发生率低于儿童。随着年龄增长,发病率上升可归因于精神状态下降和吞咽反射受损等因素,这些因素在老年人群中更为普遍。FBA的症状差异很大,从严重的急性窒息(可能涉及也可能不涉及完全气道阻塞)到更细微的症状,如咳嗽、呼吸急促(呼吸困难)、窒息或发热。这些不同的表现,再加上许多其他医疗状况可能会模仿FBA中出现的呼吸道症状,使得诊断具有挑战性。通常需要高度怀疑,尤其是在患者病史未明确指向吸入的情况下。立即处理的重点是支持气道,鉴于存在严重阻塞的可能性,这一点至关重要。影像学检查在定位异物方面起着关键作用,这对于计划取出异物至关重要。支气管镜检查,特别是可弯曲支气管镜检查,是诊断和治疗的基石。这项技术可以直接观察气道、定位异物并随后将其取出。这对于避免如果异物未及时有效取出可能出现的长期并发症至关重要。在本病例报告中,我们介绍了一名64岁女性患者,她被发现右肺下叶有一个异物,通过可弯曲支气管镜检查将其取出。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/b4abbea180c8/cureus-0016-00000053344-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/a463f5872d9a/cureus-0016-00000053344-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/1693234dd435/cureus-0016-00000053344-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/e9669ca53db9/cureus-0016-00000053344-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/6c863354ede1/cureus-0016-00000053344-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/b4abbea180c8/cureus-0016-00000053344-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/a463f5872d9a/cureus-0016-00000053344-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/1693234dd435/cureus-0016-00000053344-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/e9669ca53db9/cureus-0016-00000053344-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/6c863354ede1/cureus-0016-00000053344-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b95e/10907552/b4abbea180c8/cureus-0016-00000053344-i05.jpg

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本文引用的文献

1
Foreign body aspiration in adult airways: therapeutic approach.成人气道异物吸入:治疗方法
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Update in the extraction of airway foreign bodies in adults.成人气道异物取出术的进展
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Flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults.纤维支气管镜检查作为成人气道异物取出的首选方法。
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