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The Role Of Corticosteroids In The Perioperative Management Of Endobronchial Obstruction Due To Foreign Body Aspiration: American Thoracic Society - ATS 2011
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The Role Of Corticosteroids In The Perioperative Management Of Endobronchial Obstruction Due To Foreign Body Aspiration: American Thoracic Society - ATS 2011

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FBs, particularly those with high oil content may cause severe mucosal inflammation with formation of bulky granulation tissue. When a FB is completely encased in bulky and bleeding granulation …

FBs, particularly those with high oil content may cause severe mucosal inflammation with formation of bulky granulation tissue. When a FB is completely encased in bulky and bleeding granulation tissue, extraction can be very difficult or impossible. A short course of corticosteroids may reduce the inflammatory process and enhance recovery pre or post extraction and in some cases may facilitate removal of the FB.
 

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  • 1. The Role Of Corticosteroids In The Perioperative Management Of Endobronchial Obstruction Due To Foreign Body Aspiration Bassel Ericsoussi, M.D., Dean E. Schraufnagel, M.D., Ruxana T. Sadikot, M.B.B.S. Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Medical Center at Chicago, Chicago, IL, USA.Introduction The role of corticosteroids in the perioperativemanagement of foreign body (FB) aspiration is not wellestablished. We report the case of a patient who presentedwith chronic cough, localized bronchiectasis and recurrentpneumonia found to be secondary to foreign body-inducedgranulation tissue resulting in endobronchial occlusion. CT scan of the chest shows a soft tissue and calcific density Foreign body almost completely encased in a bulky granulation The foreign body was the head of a chicken wishbone that was measuring approximately 1.6 x 0.7 cm within the proximal right and obstructing the right lower lobe bronchus. broken off at the head and measured about 2.5 cm at its greatestPatient improved dramatically with prednisone after lower lobe bronchus. diameter.removal of FB.Case Presentation Foreign Body Removal Role of Corticosteroids A 31-year-old woman presented with chronic An alligator forceps used to remove the FB (head of a • FBs, particularly those with high oil content may causeintermittent productive cough of greenish sputum. She was chicken wishbone measuring about 2.5 cm in greatest severe mucosal inflammation with formation of bulkydiagnosed with “asthma” 5 years ago and noted to have diameter). granulation tissue.recurrent pneumonia since. Her sputum cultures repeatedly • When a FB is completely encased in bulky and bleedinggrew Pseudomonas Aeruginosa. She required several granulation tissue, extraction can be very difficult orcourses of antibiotics and steroids over the last couple of impossible.years for her poorly controlled asthma. Patient did not • A short course of corticosteroids may reduce therecall a history of aspiration or choking. Physical inflammatory process and enhance recovery pre or postexamination was notable for occasional low-pitched, CT scan of the chest shows mild localized bronchiectasis in the right extraction and in some cases may facilitate removal of themonophonic expiratory wheeze heard best over her right lower lobe distal to the Endobronchial occlusion. FB.lower chest.Imaging Fiberoptic Bronchoscopy References The Endobronchial granulation after the removal of the foreign CT scan of the chest revealed a soft tissue and calcific A diagnostic fiberoptic bronchoscopy showed a FB body. 1. Karen, L. 2002. Flexible Bronchoscopic Management of Airway Foreign Bodies in Children. Chest 121:1695-1700.density measuring approximately 1.6 x 0.7 cm within the almost completely encased in a bulky granulation and 2. Baharloo, F. 1999. Tracheobronchial Foreign Bodies : Presentation andproximal right lower lobe bronchus with localized mild obstructing the right lower lobe bronchus. Frank purulent discharge was noted coming out of the Management in Children and Adults. Chest 115:1357-1362.bronchiectasis in the right lower lobe distal to the right lower lobe bronchus. The granulation tissue resolved 3. Banerjee, A. 1988. Laryngo-Tracheo-Bronchial Foreign Bodies in Children. The Journal of Laryngology & Otology 102(11):1029-32.endobronchial occlusion. post treatment of steroids and patient remains completely asymptomatic with no further episodes of pneumonia or “asthma” attacks. Copyright © 2011 University of Illinois at Chicago. All rights reserved.