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

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.

Figure 1

CT scans, Chest. Double contour and signet ring signs are present in left upper, lingulae, and lower lobes. There is stenosis in left lower bronchus; several multiple sharp bordered nodes are evident on the left lower lobe (A and B). Follow-up CT chest revealed severe bronchial dilatation in left lower lobe 10 years after bronchial foreign body was removed (C and D).

Figure 2

Brochoscopical images. Necrotic tissues adhere to the ostium of right upper lobe bronchus (A and B) as well as right lower lobe bronchus (C), accompanied with peripheral mucosa congestion and edema. There is subtotal occlusion of the ostium of the left primary bronchus by these necrotic tissuses (D).

Figure 3

Images from repeat bronchoscopy. Bronchoscope entered the left primary bronchus, revealing a lot of necrotic tissues and purulent discharge adhering to the ostium of left upper (A) and lower lobe bronchus (B) as well as right lobe bronchus. There are still a few residual foreign bodies in the left upper segmental bronchi (C, after bronchoscopic treatment) and the left lower lobe basal segment is restored to normal after foreign body was clamped out (D, after bronchoscopic treatment).

Figure 4

Slices of Coptis chinensis.