Difficult case of differential diagnosis of partial lung atelectasis. Case report
- Authors: Gordeeva O.M.1, Egorova A.D.1, Chesalina Y.O.1, Gretcov E.M.1, Semenova L.A.1, Karpina N.L.1, Sivokozov I.V.1
-
Affiliations:
- Central Tuberculosis Research Institute
- Issue: Vol 95, No 3 (2023)
- Pages: 248-254
- Section: Clinical notes
- URL: https://journals.rcsi.science/0040-3660/article/view/132913
- DOI: https://doi.org/10.26442/00403660.2023.03.202074
- ID: 132913
Cite item
Full Text
Abstract
In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.
Full Text
##article.viewOnOriginalSite##About the authors
Olga M. Gordeeva
Central Tuberculosis Research Institute
Author for correspondence.
Email: hobbetxe@mail.ru
ORCID iD: 0000-0002-7219-003X
канд. мед. наук, науч. сотр., зав. консультативным отд., врач-фтизиатр
Russian Federation, MoscowAnna D. Egorova
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0003-0589-566X
мл. науч. сотр., врач-пульмонолог, врач-фтизиатр
Russian Federation, MoscowYana O. Chesalina
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0003-1049-5994
мл. науч. сотр., врач-эндоскопист
Russian Federation, MoscowEvgeniy M. Gretcov
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0002-2337-4692
врач-патологоанатом отд. патоморфологии, клеточной биологии и биохимии
Russian Federation, MoscowLyudmila A. Semenova
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0002-1782-7763
канд. мед. наук, ст. науч. сотр. отд. патоморфологии, клеточной биологии и биохимии, зав. отд. патологической анатомии
Russian Federation, MoscowNatalia L. Karpina
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0001-9337-3903
д-р мед. наук, рук. Центра диагностики и реабилитации заболеваний органов дыхания, зам. дир., врач-фтизиатр, пульмонолог
Russian Federation, MoscowIlya V. Sivokozov
Central Tuberculosis Research Institute
Email: hobbetxe@mail.ru
ORCID iD: 0000-0002-8170-3300
канд. мед. наук, зав. отд. эндоскопии Центра диагностики и реабилитации заболеваний органов дыхания, врач-эндоскопист
Russian Federation, MoscowReferences
- Синдромы при заболеваниях органов дыхания. Учебное пособие. Под общ. ред. Ю.В. Щукина. Самара: ООО «Научно-технический центр», 2018 [Sindromy pri zabolevaniiakh organov dykhaniia. Uchebnoe posobie. Pod obsch. red. IuV Shchukina. Samara, 2018 (in Russian)].
- Писанка В.В., Родин А.В., Стешиц А.С., Вишневский О.А. Длительно стоящее инородное тело среднедолевого бронха, симулировавшее опухоль. Эндоскопическая хирургия. 2020;26(2):39-43 [Pysanka VV, Rodin AV, Steshits AS, Vishnevsky OA. Long-standing foreign body of the middle lobe bronchus, simulating a tumor. Endoscopic Surgery. 2020;26(2):39-43 (in Russian)]. doi: 10.17116/endoskop20202602139
- Tseng HJ, Hanna TN, Shuaib W, et al. Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med. 2015;66:570-82.e575. doi: 10.1016/j.annemergmed.2015.07.499
- Lin L, Lv L, Wang Y, et al. The clinical features of foreign body aspiration into the lower airway in geriatric patients. Clin Interv Aging. 2014;9:1613-8. doi: 10.2147/CIA.S70924
- Jung SW, Kim MW, Cho SK, et al. A Case of Endobronchial Aspergilloma Associated with Foreign Body in Immunocompetent Patient without Underlying Lung Disease. Tuberc Respir Dis (Seoul). 2013;74(5):231-4. doi: 10.4046/trd.2013.74.5.231
- Huang D, Li B, Chu H, et al. Endobronchial aspergilloma: A case report and literature review. Exp Ther Med. 2017;14(1):547-54. doi: 10.3892/etm.2017.4540
- Ma JE, Yun EY, Kim YE, et al. Endobronchial aspergilloma: report of 10 cases and literature review. Yonsei Med J. 2011;52(5):787-92. doi: 10.3349/ymj.2011.52.5.787
- Kim YS, Suh JH, Kwak SM, et al. Foreign body-induced actinomycosis mimicking bronchogenic carcinoma. Korean J Intern Med. 2002;17(3):207-10. doi: 10.3904/kjim.2002.17.3.207
- Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990;112(8):604-9. doi: 10.7326/0003-4819-112-8-604
- Chouabe S, Perdu D, Deslée G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest. 2002;121(6):2069-72. doi: 10.1378/chest.121.6.2069
- Trisolini R, Dore R, Bertolini R, et al. Longstanding endobronchial foreign body. Diagn Ther Endosc. 1999;5(4):257-61. doi: 10.1155/DTE.5.257
- Watanabe H, Uruma T, Tazaki G. Tracheobronchial foreign body aspiration demonstrating serial bronchopulmonary changes on computed tomography. Iran Red Crescent Med J. 2014;16(5):e18199. doi: 10.5812/ircmj.18199
Supplementary files
![](/img/style/loading.gif)