Foreign Body Aspiration as a Cause of Chronic Recurrent Pneumonia
Theo D. Trandafirescu, Adina A. Trandafirescu. Medicine, Mount Sinai Services, Queens Hospital Center, Flushing, New York, United States
Purpose of Study Foreign body (FB) aspiration is a serious medical condition demanding early recognition and prompt action.
Methods Used 52 smoker male with PMH of DM and asthma presented with cough with greenish sputum, fever and worsening SOB for one week.Patient reported being diagnosed with pneumonia several times per year for the last 10 yrs. CT showed bilateral diffuse centrilobular nodules with RUL predominance,bronchiolar wall thickening and ectatic changes and a calcified FB in the right bronchus intermedius.Patient was placed on broad spectrum antibiotics and steroid regimen with symptomatic improvement. Bronchoscopy was performed with successful removal of the FB measuring 1.2 x 0.7 x 0.4 cm.
Summary of Results FB aspiration is most commonly secondary to unconscious accidental indigestion. Special situations can be also related such as anesthesia, sedation, intoxication, seizures or neurologic disorders affecting the oropharynx. FB can be dietary or non-dietary but both are associated with similar consequences.Although clinical presentation of airway FB depends on the site of impaction, there may be minimal symptoms if the FB passes into the bronchi.Classic triad of cough, wheezing and chocking is only present in a small percentage of patients.Most common site of impaction in the RLL because it is anatomically larger are more vertical creating continuity with the trachea. Because of the absence of specific symptoms, adult airway FBs diagnosis if often delayed.Complications to FB aspiration include but are not limited to recurrent pneumonia, bronchial stenosis, bronchiectasis, recurrent hemoptysis, chronic lung disease, pleural effusion and empyema.FB can also mimic other pulmonary entities such as asthma, lung cancer or tuberculosis. Diagnosis is made by chest radiography in most cases, although CT of the chest can be valuable when identifying small aspirated objects. Flexible Bronchoscopy is preferred in adults and is both diagnostic and therapeutic. Surgical removal constitutes the final option and is generally well tolerated
Conclusions Occult tracheobronchial FB are rare in adult population and are usually incidentally detected during radiological test or chest tomography. Flexible bronchoscopy the best option for both diagnosis and treatment.
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