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Pulmonary Procedures |

Endobronchial Actinomycosis With Chicken Bone Vertebra: A Bronchoscopic Laminectomy

Faria Nasim, MD; Anas Hadeh, MD; Laurence Smolley, MD; Eduardo Oliveira, MD
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Cleveland Clinic Florida, Weston, FL


Chest. 2014;146(4_MeetingAbstracts):756A. doi:10.1378/chest.1993711
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Abstract

SESSION TITLE: Bronchology/Interventional Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Endobronchial actinomycosis is exceedingly rare. Endobronchial actinomycosis may mimic bronchial carcinoma, bronchiectasis or pneumonitis.1 We describe the ninth case of endobronchial actinomycosis associated with the aspiration of a chicken bone.

CASE PRESENTATION: A 73 yr-old-female was seen for 5 weeks history of cough, dyspnea on exertion and wheezing. Her cough was productive of yellow sputum and intermittent small volume hemoptysis. Her problems started after she accidentally aspirated a chicken bone. She was treated for bronchospasm with bronchodilators and steroids by her primary physician. She had undergone a rigid bronchoscopy in Jamaica before coming to the US to seek medical care. Her rigid bronchoscopy revealed inflammation and an endobronchial polypoid lesion at the left main bronchus was biopsied. (Image 1A) Biopsy was non diagnostic. PET CT showed hypermetabolic foci at left mainstem bronchus. (Image 1B) We performed a fiberoptic bronchoscopy. Her left lung main stem bronchus was occluded with a piece of bone surrounded by extensive granulation tissue. (Image 2A) The bone was retrieved with an oval snare. Fragments of bone retrieved resembled chicken vertebra. (Image 2B) GMS positive colonies of actinomyces grew on the pathology specimen. Patient was committed to treatment with Penicillin.

DISCUSSION: Although it is known that endobronchial actinomycosis can closely mimic bronchial carcinoma, the association between endobronchial actinomycosis and foreign body is rare. To the best of our knowledge only 15 endobronchial actinomycosis cases associated with foreign body aspiration are reported in the medical literature to date. 8 of these cases were associated with chicken bone aspiration. As in our case, bronchial carcinoma was suspected in half of these cases.2 There was a history of choking in our patient which should aid in the consideration of this rare presentation which can be treated with antibiotics after extraction of the foreign body.

CONCLUSIONS: Endobronchial actinomycosis must be considered in the differential diagnosis of an endobronchial mass, as well as a complication of foreign body aspiration.

Reference #1: Ariel et al. Endobronchial actinomycosis simulating bronchogenic carcinoma. Diagnosis by bronchial biopsy. Chest 1991 Feb; 99(2):493-5.

Reference #2: Chouabe et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest 2002 Jun; 121(6):2069-72.

DISCLOSURE: The following authors have nothing to disclose: Faria Nasim, Anas Hadeh, Laurence Smolley, Eduardo Oliveira

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