ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA
Chest
; 162(4):A2083, 2022.
Article
in English
| EMBASE | ID: covidwho-2060896
ABSTRACT
SESSION TITLE Case Reports of Procedure Treatments Posters SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION:
Foreign body aspiration can affect ventilation-oxygenation dynamics causing significant morbidity and mortality in children and adults. Patient presentation can range from asymptomatic to life-threatening hypoxia. A thorough history and physical examination helps in narrowing differential diagnosis and provision of timely management. A myriad of complications can occur from aspirated Foreign body including recurrent pneumonia, lung abscess, obstructive emphysema, and death. Here we present a case of a patient with recurrent pneumonia from a chronically aspirated foreign body. CASE PRESENTATION 37-year-old male with past medical history of a recent COVID-19 infection and bronchus intermedius endobronchial mass (squamous metaplasia on biopsy 2009) who presented with fever, chest pain, worsening dyspnea. Initial workup was consistent with severe sepsis. A CT chest showed complete collapse, cavitation in right lower lobe and presence of right bronchus stent. Patient was treated with IV fluids and antibiotics during the hospitalization. He underwent bronchoscopy for airway examination and bronchoalveolar lavage. Airway exam showed a large endobronchial mass in the bronchus intermedius. Endobronchial biopsies were taken, followed by tissue debulking using flexible forceps and cryoprobe. A yellow plastic foreign object was then visualized dislodged in the right lower lobe. This was successfully removed with grasping forceps. Patient had to be extubated and be reintubated to remove foreign object in one piece as it did not fit the endotracheal tube. Post debulking, bronchus intermedius and right lower lobe were patent and procedure was completed. Our patient responded well to treatment he was ultimately transitioned to oral antibiotics and discharged home with outpatient follow up. Repeat bronchoscopy 6 weeks later showed normal airways.DISCUSSION:
Our case illustrated the importance of thorough investigation while treating patients with recurrent pneumonia, and this sometimes should include bronchoscopy with airway exam. In our case a bronchoscopy was done several years ago, however the foreign body was not identified as the cause of the endobronchial lesion. A lingering foreign body in the long run has significant morbidity as seen in our case despite appropriate treatment with antibiotics patient continued to have recurrent post obstructive pneumonias. Bronchoscopy remains the gold standard in definitive diagnosis and management of foreign body. Since the refinement of bronchoscopy and debulking, the rate of mortality from foreign body aspiration has been remarkably reduced.CONCLUSIONS:
In summary patients with history suggestive of potential foreign body aspiration presenting with recurrent pneumonias at a particular anatomical location should prompt physicians to perform diagnostic bronchoscopy, which remains the gold standard for diagnosing of foreign body aspiration Reference #1 Foreign Body Aspiration Natan Cramer;Noel Jabbour;Melissa M. Tavarez;Roger S. Taylor. DISCLOSURES No relevant relationships by Maria Abril No relevant relationships by Bilal Bangash No relevant relationships by Imran Tarrar
antibiotic agent; adult; anatomical location; artificial ventilation; bronchoscopy; bronchus; case report; child; clinical article; collapse; complication; conference abstract; coronavirus disease 2019; cryoprobe; diagnosis; differential diagnosis; drug therapy; dyspnea; emphysema; endotracheal tube; fever; follow up; foreign body aspiration; gold standard; grasping forceps; hospitalization; human; human tissue; hypoxia; lung abscess; lung lavage; male; medical history; Melissa officinalis; morbidity; mortality; necrotizing pneumonia; nonhuman; obstructive pneumonia; outpatient; oxygenation; patent; physical examination; physician; pneumonia; sepsis; squamous cell metaplasia; stent; thorax pain
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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