Chronic cough and noisy breathing: An 11-year journey to diagnosis and successful treatment

Abstract

Foreign body aspiration in an uncommon entity in adults which often leads to delays in diagnosis. Adults with long-standing foreign bodies in the airway can result in various complications including bronchiectasis, atelectasis and lung fibrosis. We describe the case of a primary school teacher who was diagnosed with foreign body aspiration 11 years after the aspiration event. Delays in diagnosis led to her receiving multiple doses of antibiotics including a course of antituberculous therapy.

Keywords: Bronchoscopy; Chronic cough; Foreign body.

Fig. 1

Fibrotic changes and scattered cavitation seen in the left apical region, reduced left lung volume with traction bronchiectasis. There were also small centrilobular nodules in a linear branching pattern in the left lung resembling tree in bud appearance suggestive for bronchiolitis.

Fig. 2

Bronchoscopy image showing a foreign body in the left main bronchus.

Fig. 3

Piece of sweet shell (plastic wrap) removed from the left main bronchus.

Fig. 4

Chest-Xray after foreign body removal showing fibrosis, bronchiectasis and reduced left lung volume with few small bullae in upper pole.

Fig. 5

Review of the first CT scan images showed a high-density foreign body (approximately – 250 HU density) is seen in the left main bronchus, approximately about 2.86 cm distal to carina impacted at the bifurcation into the 2 lobar bronchi, the left upper and lower lobar bronchi. (black arrow). Furthermore, there was a hypodense opacity in the left lower lobe that was best seen in coronal views with classic finger in glove appearance which represents mucous filling dilated bronchi (20-28 HU density) consistent with mucoid impaction.