Successfully removed the bone segment stuck in the bronchus by bronchoscopy with anesthetic soft tube

The article was written by Doctor Nguyen Ngoc Bach - Respiratory Specialist, Vinmec Times City International Hospital.

Bronchial foreign body is a rare situation in respiratory specialist medical examination and treatment. Clinical manifestations vary widely, from simple persistent cough unresponsive to medical treatment to severe infection to cases of long-standing bronchial foreign body that has been infected with bacteria and is more severe than chemotherapy. Purulent foci cause difficult management and prolonged hospital stay.
With many clinical manifestations, bronchial foreign bodies need to be avoided by taking a careful history, comprehensive examination, and appropriate imaging studies to avoid pulmonary complications. due to late detection and treatment.
Below is a case of bronchial foreign body in an adult with persistent cough symptoms after 1 meal of choking. The patient went to the doctor and took medicine for more than 1 month but the symptoms did not improve. When going to a doctor specializing in Respiratory Medicine, Department of General Internal Medicine, Vinmec Times City General Hospital, the patient underwent bronchoscopy to remove a foreign body which is a piece of animal bone.

67-year-old male patient.
Reason for going to the doctor: Cough persists
History: 1 month disease course, starting after a meal, choking, the patient appears to have a lot of cough, dry cough, after coughing little sputum, accompanied by a feeling of heaviness in the chest , shortness of breath intermittently of mild severity, no fever. The patient went to the doctor and took medicine but did not help.
Patient comes to the clinic with a tired appearance, no signs of respiratory failure, signs of infection are not clear, patient contact is alert, answers are clear. On examination of the right lung, there was a slight gurgling sound at the base. The patient's hemodynamics were stable.
On the patient's chest CT scan: There are no abnormalities in the lung parenchyma on both sides, observing the right bronchus, suspicious of foreign bodies.

Diagnosis: Persistent cough with a strong suspicion of a foreign body in the right bronchus
The patient has been evaluated and prepared for bronchoscopy under anesthesia.
When bronchoscopy evaluates:
The lining of the trachea is congested, with mild erosive ulcers in many places.

When the bronchoscope was brought to Carina, the location of the foreign body was observed in the right medial bronchus.

Conduct observation and assessment of the surrounding bronchial segments and proceed to remove the foreign body from the bronchial tree.

The bronchial foreign body is a piece of bone 1.5cm long, hard, with a sharp end. According to the evaluation of doctors, when the patient coughs, the foreign body can move and scratch, superinfect and ulcerate the bronchial mucosa. For these foreign bodies, long-term exposure can cause perforation, purulent inflammation, and abscess in the bronchi.

After removing the foreign body, carefully examine the segmental bronchi and wash the bronchi to collect the right basal and middle bronchial fluid for culture evaluation. After endoscopy, patients were closely monitored for vital signs and checked after 12 hours. When the patient is stable, they are prescribed to go home for treatment

Foreign bodies in the airways in adults are rare in practice in the treatment of respiratory pathology and often occur in subjects with risk factors (neuropathies with impaired cough and swallowing reflexes or drug abusers). sedation, alcohol) or in favorable circumstances (laughing, crying, choking during meals,...). Careful examination of the patient to detect foreign body penetration into the trachea is very important to guide the diagnosis.
In adults, the infiltrative syndrome is rarely reported when the patient comes to the clinic, the main symptoms of which are persistent cough and persistent infection of the respiratory tract that are easily confused with other conditions. Clinical examination in combination with Imaging is meaningful to supplement factors that help confirm diagnosis, local diagnosis as well as the state of infection and the risk of foreign body removal (bleeding, emphysema in the lungs). manager). However, normal clinical and radiological examination results do not exclude the diagnosis of airway foreign body, so patients with suspicious manifestations: Persistent cough, recurrent and persistent respiratory infections need to be treated. Ask for bronchoscopy to probe and rule out.
Currently at Vinmec hospital, bronchoscopy with anesthesia is a modern technique that does not make patients uncomfortable when conducting endoscopy: choking, feeling asphyxiated,... The patient is Indications Soft bronchoscopy under anesthesia and use of assistive devices to remove foreign bodies. After being anesthetized and carefully controlling the airway to ensure safety and limit the patient's discomfort and irritation, the doctors performed a convenient endoscopic technique, removed the foreign body and then examined the patient. , control to ensure no complications for the patient.
According to the recommendation of Dr. Nguyen Ngoc Bach to prevent bronchial foreign bodies, you should:
When eating, limit emotions: Laughing, being too angry can lead to choking. Try to remove animal bones from dishes, especially for young children. If dentures are loose, broken hooks, ... should go to the doctor and correct them immediately. When there are signs of suspicion of foreign bodies, they should immediately go to specialized medical facilities to avoid possible complications due to not being treated promptly.