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"Chronic bronchial foreign body managed by lobectomy and latissimus dorsi flap: case report"
Aditi Dalvi1, Maitreyee Save1, Paras Kothari1
1Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai 400022, Maharashtra, India.
Insights
Occult foreign body aspiration can mimic chronic respiratory disease, leading to delayed diagnosis. Early surgical intervention is recommended for impacted foreign bodies to avoid complications from repeated bronchoscopies.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Diagnostic Challenges in Respiratory Medicine
Background:
- Foreign body aspiration is a frequent cause of respiratory distress across all age groups.
- It often presents with non-specific symptoms, mimicking chronic respiratory conditions, leading to diagnostic delays and misdiagnosis.
Observation:
- A case of an 11-year-old boy with an occult foreign body chronically impacted in the left secondary bronchus is presented.
- The patient exhibited bronchiectasis and underwent multiple unsuccessful bronchoscopic retrieval attempts.
Findings:
- Surgical management with a left lower lobe lobectomy via mini-thoracotomy, augmented by a latissimus dorsi flap, was successfully performed.
- Upfront surgical intervention can mitigate the morbidity associated with repeated bronchoscopic procedures, including post-operative ventilation and anesthesia risks.
Implications:
- A high index of suspicion is crucial for diagnosing foreign body aspiration, especially in atypical presentations.
- Surgical management should be considered early for chronic foreign body impactions to prevent long-term complications and reduce procedural risks.
Introduction And Importance:
Foreign body aspiration is a common occurrence, with severe outcomes seen in all age groups. It can present like any chronic respiratory disease with a wide spectrum of misleading symptoms, resulting in misdiagnosis and delays in appropriate treatment.
Case Presentation:
Here we present a case of a 11 year boy diagnosed with occult foreign body aspiration, chronically impacted in the left secondary bronchus, presented with bronchiectasis and multiple failed attempts at bronchoscopic retrieval.
Clinical Discussion:
Surgically managed by a left lower lobe lobectomy via a mini thoracotomy, reinforced with a pedicled latissimus dorsi flap. Upfront surgery will reduce the bronchoscopic morbidity incurred in repeated attempts needing pot-op ventilatory support due to edema and repeated general anaesthesia risks.
Conclusion:
A high degree of suspicion is a key to diagnosis. There should be a low threshold for surgical management in chronic impactions.
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