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解析异物对支气管扩张的影响:来自病例系列研究的见解

Unravelling the Impact of Foreign Bodies on Bronchiectasis: Insights From a Case Series Study.

作者信息

Kumar T Prasanna, Vananjakar Shashidhar S, Saleem Tanisha, Rao D Pragati, Vijayan Sruthy

机构信息

Respiratory Medicine, M S Ramaiah Medical College and Hospital, Bangalore, IND.

出版信息

Cureus. 2024 Sep 15;16(9):e69475. doi: 10.7759/cureus.69475. eCollection 2024 Sep.

Abstract

Foreign body (FB) aspiration in adults is a rare yet critical event that can mimic chronic respiratory conditions such as asthma or bronchitis, often causing delays in diagnosis and treatment. This case series explores the presentations of four adult patients, each with a prolonged history of chronic cough, who were later discovered to have aspirated foreign bodies. Initial misdiagnoses and the limitations of high-resolution CT scans in detecting these foreign bodies contributed to delays in reaching an accurate diagnosis. Interestingly, three of the cases involved aspirated vegetative matter, which went undetected on imaging and was only identified through bronchoscopy. The fourth patient, a young adult male, had aspirated a safety pin, which led to empyema, a severe complication highlighting the risks associated with delayed diagnosis. A key finding in this series is the significant role of flexible bronchoscopy in both diagnosing and managing FB aspiration. In each case, flexible bronchoscopy, guided through a rigid bronchoscope, was instrumental in successfully removing the foreign bodies, even in complex cases involving vegetative material or sharp objects. This case series underscores the importance of considering FB aspiration in adults with unexplained chronic cough, especially when conventional imaging does not reveal a clear cause. The diagnosis of airway foreign body requires a thorough clinical history and assessment of risk factors, with bronchoscopy serving as a crucial diagnostic and therapeutic tool when CT scans are inconclusive and stressing the need for timely diagnosis and intervention to prevent severe complications and improve patient outcomes.

摘要

成人异物误吸是一种罕见但严重的情况,可能会模仿哮喘或支气管炎等慢性呼吸道疾病,常常导致诊断和治疗延迟。本病例系列探讨了四名成年患者的临床表现,他们都有长期慢性咳嗽病史,后来被发现误吸了异物。最初的误诊以及高分辨率CT扫描在检测这些异物方面的局限性导致了准确诊断的延迟。有趣的是,其中三例涉及误吸植物性物质,影像学检查未发现,仅通过支气管镜检查才得以识别。第四例患者是一名年轻成年男性,误吸了一枚安全别针,导致脓胸,这一严重并发症凸显了延迟诊断的风险。本系列的一个关键发现是可弯曲支气管镜在诊断和处理异物误吸方面的重要作用。在每个病例中,通过硬支气管镜引导的可弯曲支气管镜在成功取出异物方面发挥了重要作用,即使在涉及植物性物质或尖锐物体的复杂病例中也是如此。本病例系列强调了在患有不明原因慢性咳嗽的成年人中考虑异物误吸的重要性,特别是当传统影像学检查未发现明确病因时。气道异物的诊断需要全面的临床病史和危险因素评估,当CT扫描结果不明确时,支气管镜检查作为关键的诊断和治疗工具,强调了及时诊断和干预以预防严重并发症并改善患者预后的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4312/11479866/d324483db883/cureus-0016-00000069475-i01.jpg

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