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Diagnose of occult bronchial foreign body: A rare case report of undetected Chinese medicine aspiration for 10 long years.

Wang L, Pudasaini B, Wang XF - Medicine (Baltimore) (2016)

Bottom Line: A battery of tests were given to confirm the diagnosis.This case clearly demonstrates that a precise medical history is often overlooked.A high index of suspicion, a precise medical history, radiographic features of chronic respiratory symptoms not explained by other conditions were keys to diagnosing this case.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Pulmonary Medicine, The first affiliated of Zhejiang University School of medicine, Hangzhou, China bDepartment of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Shanghai.

ABSTRACT

Background: Occult bronchial foreign body can be very difficult to diagnose early in an adult patient without acute symptoms. This report describes a rare case of undetected Chinese medicine "Coptis chinensis" aspiration for 10 long years.

Methods: A case was reported that a female patient complained of a 10-year history of productive cough. A battery of tests were given to confirm the diagnosis.

Results: Chest computed tomography (CT) showed extensive bronchiectasis and multiple nodules, along with stenosis of left lower lobar bronchus. An extensive solid lesion with surrounding inflammatory granulation tissue was seen on her first bronchoscopy and biopsy revealed chronic mucosal inflammation. A neglected history of Coptis chinensis regularly kept in-mouth while sleeping for the last 10 years in this patient provided clues for a final diagnosis. Confirmatory diagnosis of bilateral tracheobronchial foreign bodies caused by recurrent inhalation of Coptis chinensis was made by a second bronchoscopy.

Conclusions: This case clearly demonstrates that a precise medical history is often overlooked. A high index of suspicion, a precise medical history, radiographic features of chronic respiratory symptoms not explained by other conditions were keys to diagnosing this case.

No MeSH data available.


Related in: MedlinePlus

Slices of Coptis chinensis.
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Figure 4: Slices of Coptis chinensis.

Mentions: A neglected history of Chinese medicine kept-in-mouth while sleeping since the last 10 years in this patient provided clues for a final diagnosis. The patient used Coptis chinensis, a Chinese herbal medicine with an extraordinarily bitter taste, to alleviate discomfort of parageusia. The bronchoscope entered the left lower bronchus on the second session. A lot of necrotic tissues and purulent secretions adhering to the ostium of left lobe bronchus as well as right lobe bronchus were seen. A scrap of hard material was clamped during biopsy, which was confirmed to be a foreign body eventually (Fig. 3). Subsequently, bronchoscopy clamped out the foreign bodies from each segmental bronchus piece by piece except left upper segmental bronchi. Bilateral tracheobronchial foreign bodies caused by recurrent inhalation of Coptis chinensis is the final diagnosis (Fig. 4).


Diagnose of occult bronchial foreign body: A rare case report of undetected Chinese medicine aspiration for 10 long years.

Wang L, Pudasaini B, Wang XF - Medicine (Baltimore) (2016)

Slices of Coptis chinensis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979771&req=5

Figure 4: Slices of Coptis chinensis.
Mentions: A neglected history of Chinese medicine kept-in-mouth while sleeping since the last 10 years in this patient provided clues for a final diagnosis. The patient used Coptis chinensis, a Chinese herbal medicine with an extraordinarily bitter taste, to alleviate discomfort of parageusia. The bronchoscope entered the left lower bronchus on the second session. A lot of necrotic tissues and purulent secretions adhering to the ostium of left lobe bronchus as well as right lobe bronchus were seen. A scrap of hard material was clamped during biopsy, which was confirmed to be a foreign body eventually (Fig. 3). Subsequently, bronchoscopy clamped out the foreign bodies from each segmental bronchus piece by piece except left upper segmental bronchi. Bilateral tracheobronchial foreign bodies caused by recurrent inhalation of Coptis chinensis is the final diagnosis (Fig. 4).

Bottom Line: A battery of tests were given to confirm the diagnosis.This case clearly demonstrates that a precise medical history is often overlooked.A high index of suspicion, a precise medical history, radiographic features of chronic respiratory symptoms not explained by other conditions were keys to diagnosing this case.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Pulmonary Medicine, The first affiliated of Zhejiang University School of medicine, Hangzhou, China bDepartment of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital,Tongji University School of Medicine, Shanghai.

ABSTRACT

Background: Occult bronchial foreign body can be very difficult to diagnose early in an adult patient without acute symptoms. This report describes a rare case of undetected Chinese medicine "Coptis chinensis" aspiration for 10 long years.

Methods: A case was reported that a female patient complained of a 10-year history of productive cough. A battery of tests were given to confirm the diagnosis.

Results: Chest computed tomography (CT) showed extensive bronchiectasis and multiple nodules, along with stenosis of left lower lobar bronchus. An extensive solid lesion with surrounding inflammatory granulation tissue was seen on her first bronchoscopy and biopsy revealed chronic mucosal inflammation. A neglected history of Coptis chinensis regularly kept in-mouth while sleeping for the last 10 years in this patient provided clues for a final diagnosis. Confirmatory diagnosis of bilateral tracheobronchial foreign bodies caused by recurrent inhalation of Coptis chinensis was made by a second bronchoscopy.

Conclusions: This case clearly demonstrates that a precise medical history is often overlooked. A high index of suspicion, a precise medical history, radiographic features of chronic respiratory symptoms not explained by other conditions were keys to diagnosing this case.

No MeSH data available.


Related in: MedlinePlus