Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports
Abstract Background Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The d...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-10-01
|
| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12887-019-1783-1 |
| _version_ | 1819084514437103616 |
|---|---|
| author | Anna Rieth Tamás Kovács Zoltán Novák Katalin Kapus Aurél Ottlakán Tibor Németh József Furák |
| author_facet | Anna Rieth Tamás Kovács Zoltán Novák Katalin Kapus Aurél Ottlakán Tibor Németh József Furák |
| author_sort | Anna Rieth |
| collection | DOAJ |
| description | Abstract Background Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope. Case presentation We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions. Conclusions Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy. |
| first_indexed | 2024-12-21T20:49:40Z |
| format | Article |
| id | doaj.art-3509bf1bd4f74ceeb7a14833194c2e1b |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-21T20:49:40Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-3509bf1bd4f74ceeb7a14833194c2e1b2022-12-21T18:50:44ZengBMCBMC Pediatrics1471-24312019-10-011911510.1186/s12887-019-1783-1Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reportsAnna Rieth0Tamás Kovács1Zoltán Novák2Katalin Kapus3Aurél Ottlakán4Tibor Németh5József Furák6Division of Pediatric Surgery, Department of Pediatrics, University of SzegedDivision of Pediatric Surgery, Department of Pediatrics, University of SzegedDivision of Pediatric Pulmonology, Department of Pediatrics, University of SzegedDivision of Pediatric Pulmonology, Department of Pediatrics, University of SzegedDivision of Thoracic Surgery, Department of Surgery, University of SzegedDivision of Thoracic Surgery, Department of Surgery, University of SzegedDivision of Thoracic Surgery, Department of Surgery, University of SzegedAbstract Background Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope. Case presentation We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions. Conclusions Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy.http://link.springer.com/article/10.1186/s12887-019-1783-1Awn aspirationBronchopleural fistulaBronchiectasisLung resection |
| spellingShingle | Anna Rieth Tamás Kovács Zoltán Novák Katalin Kapus Aurél Ottlakán Tibor Németh József Furák Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports BMC Pediatrics Awn aspiration Bronchopleural fistula Bronchiectasis Lung resection |
| title | Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports |
| title_full | Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports |
| title_fullStr | Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports |
| title_full_unstemmed | Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports |
| title_short | Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports |
| title_sort | surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis case reports |
| topic | Awn aspiration Bronchopleural fistula Bronchiectasis Lung resection |
| url | http://link.springer.com/article/10.1186/s12887-019-1783-1 |
| work_keys_str_mv | AT annarieth surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT tamaskovacs surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT zoltannovak surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT katalinkapus surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT aurelottlakan surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT tibornemeth surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports AT jozseffurak surgicaltreatmentofawnaspirationcausingbronchopleuralfistulaandbronchiectasiscasereports |