SESSION TITLE: Airway Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Chronic cough is a common complaint in pulmonary medicine. We present an uncommon cause of chronic cough in an otherwise healthy adult.
CASE PRESENTATION: An 86-year old Caucasian male with history of hypothyroidism and hyperlipidemia presented with cough for one year. His cough was initially non-productive, mostly positional and occurs when he lies on his right side and also when he stands up. He was a lifelong non-smoker and denied history of asthma, gastroesophageal reflux symptoms, post-nasal drip or angiotensin converting enzyme inhibitor use. He denied weight loss or night sweats. His cough eventually became progressive and productive of yellowish sputum and he was noted to have fevers. These symptoms persisted despite courses of Azithromycin and Levofloxacin for presumed bronchitis. Physical examination revealed an elderly gentleman, speaking in full sentences, not ill appearing, and not in respiratory distress. He was febrile to 101F with oxygen saturation of 96% on room air. Lung examination revealed symmetric chest expansion with right basilar dullness to percussion, rhonchi, egophony, and increased tactile fremitus. Review of his chest x-ray 10 months prior to presentation revealed mild right basilar discoid atelectasis. Chest x-ray on presentation revealed right basilar discoid atelectasis with lateral view showing increased opacification of the right lower lobe. Subsequent chest computed tomography (CT) revealed right lower lobe consolidation and atelectasis with an endobronchial object seen proximal to the takeoff of the right lower lobe bronchi (Figure 1). Fiberoptic bronchoscopy revealed an endobronchial obstruction at the takeoff of the right lower lobe bronchi by a globular mucus-coated piece of organic material (Figure 2). Forceps and cryotherapy were employed to remove the object, and copious mucopurulent secretions were seen distally. Pathological analysis of the foreign body was consistent with vegetable matter. After the foreign body was removed, the patient was treated with a course of Augmentin with complete resolution of his cough and fever.
DISCUSSION: Foreign body aspiration in adults can be subtle and remain undetected for years if the foreign body is small enough to lodge in the lobar or segmental bronchus. Cough is the most common symptom. Radiologic findings can include atelectasis, air trapping, and pneumonia. Treatment is removal of the foreign body. Most frequent procedure is fiberoptic bronchoscopy.
CONCLUSIONS: One needs to have a high index of suspicion to diagnose aspiration if cough does not resolve with the usual empiric therapy, especially if there is pneumonia that does not respond to standard treatment.
Reference #1: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies. Presentation and management in children and adults. Chest. 1999;115:1357-62.
DISCLOSURE: The following authors have nothing to disclose: Jeffrey Albores, Joanne Bando
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