Foreign body aspiration for 17 years

1. Case Study

2.  Bệnh nhân nữ, 44 tuổi.
 Lí do vào viện: ho, đau tức ngực trái khoảng 1 tháng nay.
 Tiền sử: Basedow đã điều trị cách 4 năm.
 Dị ứng: chưa phát hiện
 Khám vv:
-Không khó thở, không sốt
- Đau tức ngực trái.
- Rales ẩm phổi trái.
- Công thức máu: bình thường.
- Hóa sinh máu : FT3, FT 4, TSH: bình thường
- Crp: 6,1 ng/ml
- ECG: bình thường

3. xq ngực:

4. Đo chức năng hô hấp: rối loạn thông khí tắc nghẽn

5. Nội soi phế quản lần 1: tổn thương td tổ chức hạt, gây hẹp ½
phế quản gốc trái, không quan sát thấy dị vật.

6. Xét nghiệm dịch rửa phế quản
AFP: (-)
Nấm: (-)
Tế bào học: không phát hiện tế bào bất thường, ít tế bào viêm.
Vi khuẩn: pseudomonas aeruginosa nhạy cảm imirpenem.

7. Ct ngực: cấu trúc tăng tỉ trọng 300HU, vị trí phế quản chính
T ngay chỗ chia nhánh.

8. Tổn thương viêm phổi thùy trên. Giãn phế quản thùy dưới.

9. Hỏi kĩ lại bệnh sử
Khoảng 2002, bệnh nhân đang ăn thịt ngan, bị hóc, ho sặc sụa
tuy nhiên dấu hiệu qua nhanh, bệnh nhân không chú ý.
Sau đấy, bệnh nhân xuất hiện ho dai dẳng kéo dài, viêm đường
hô hấp tái diễn nhiều đợt mỗi năm.

10. Bệnh nhân được nội soi phế quản lần 2 lấy dị vật

12. Overview
 Foreign body (FB) aspiration is an uncommon but potentially life-
threatening event, accounting for 0.16–0.33% of adult bronchoscopic
procedures.
 The majority of accidental aspiration events occur in children (<5 years),
adults represent up to 25% of cases.
 In children <15 years of age, foreign bodies lodge within the left lung
almost as often as in the right lung, in adult aspiration will be more
common in the right lung.
 According to the National Safety Council, in 2016 the rate of fatal choking
in American children <5 years of age in the general population was 0.43
per 100,000.

13. Symptoms and initial evaluation
 Patient history is helpful in the evaluation of patients with suspected FB
aspiration.
 The classically described “penetration syndrome,” consisting of a choking
episode followed by intractable cough is more common in children than in adults.
 The most common symptom: cough, sudden onset of cough. Less common
symptoms include wheezing, dyspnea, hemoptysis, chest pain, and recurrent
pneumonia.
 Between 2% -10% asymptomatic.

14. RADIOLOGY
X-RAY
 Chest radiographs are often utilized as initial tool of investigation for foreign body
aspiration.
 However, in multiple studies: normal. up to 80% of foreign bodies are not visible on
chest x-ray
 Radiological findings consistent with a foreign body aspiration include atelectasis,
pneumothorax, and air trapping.
 The most common abnormality was air trapping, 53%.
 If a foreign body cannot be seen with a traditional X-ray, then inspiratory and
expiratory phase films may show air-trapping which suggests an aspirated foreign
body.
 If the radiographs are unrevealing, a CT of the chest should be performed.

16. RADIOLOGY
Computed tomography
 Chest computed tomography (CT) is more sensitive for identification of FBs
 The gold standard of imaging studies when a FB aspiration is suspected
 Virtual bronchoscopy via CT :sensitivity 100% and specificity 75%. It can
help predict which tools may be needed prior to bronchoscopy .
 Additional findings on CT of the chest can include: atelectasis,
bronchiectasis, lobar consolidation,..

18. DIAGNOSIS
 The diagnosis of an aspirated foreign body is based on a combination
of the history, presenting symptoms, and chest X-rays, CT (if xray
normal) and/ or bronchoscopy.

19. Differential Diagnosis
 Pneumonia
 Asthma
 COPD
 Emphysema
 Lung abscess
 Tuberculosis
 …

20. COMPLICATION
 A myriad of complications including: recurrent pneumonia, bronchiectasis,
bronchial stenosis, tracheal lacerations, emphysema, lung abscess, and atelectasis
can occur from a missed foreign body aspiration.
 Tracheal lacerations are the most commonly reported complication among affluent
countries.
 Pneumonia is the most common complication among countries with a
poorer socioeconomic status.

21. TREATMENT
 Use bronchoscopy and remove the offending object.
 Rigid bronchoscopy have several key benefits compared to flexible bronchoscopy:
 1) The ability to ventilate via the rigid bronchoscope
 2) Improved visualization with a rigid telescope
 3) Greater versatility to accommodate various sizes of suctioning and optical
forceps.
 4, The rigid scope offers a wider space to manipulate the offending object and to
facilitate removal while avoiding obstruction at the level of the glottis.
 In cases of diagnostic uncertainty, a flexible bronchoscopy may be the preferred
initial test or a flexible bronchoscopy is the first choice, if fail, use rigid
bronchoscopy

22. Thanks you