Delayed Diagnosis and Treatment of Occult Bronchial Foreign Body in Adults with Chronic Cough as the Main Symptom and Literature Review

JIA Weihong; HUO Xueqing; AI Nana; WANG Yuanyuan; YANG Dongcai; YANG Qian; HE Jun; ZHANG Hui

doi:10.3969/j.issn.1002-3429.2024.01.002

Abstract：Objective To explore the clinical characteristics,diagnosis and treatment experience of occult bronchial foreign body(OBFB)in adults.Methods The data of 4 adults with OBFB admitted from February 2017 to July 2023 were retrospectively analyzed based on literature review.Results Among the 4 patients,only 1 patient had cerebral vascular acci-dent leading to long-term bed rest and bronchial foreign body aspiration,and the other 3 patients were normal adults.The main clinical manifestations were chronic cough.They were misdiagnosed as pneumonia(n =2),pulmonary abscess(n =1)and bronchitis(n =1),respectively,and the diagnosis was confirmed by bronchoscopy.After diagnosis,bronchial foreign bodies in 3 patients were removed under general anesthesia,and the other patient was changed to general anesthesia after fail-ure of tracheoscopy under local anesthesia,and no complications occurred.Among the 4 patients,1 patient had animal foreign body(duck neck),2 patients had plant foreign body(melon seed kernel,vegetable stem,chili horn),and 1 patient had metal object(tinfoil).Misdiagnosis lasted from 3 months to 10 years.Conclusion Bronchial foreign bodies in adults are rare and have varying clinical manifestations.Most non-metallic foreign bodies or plant foreign bodies show negative results in the early stage of chest imaging examination,which can lead to delayed diagnosis and treatment of foreign bodies,causing ate-lectasis and granulation tissue hyperplasia,and recurrent pneumonia.Bronchial foreign bodies in adults have the characteris-tics of high misdiagnosis rate and long duration of delayed diagnosis.Tracheoscopy under general anesthesia is the most effec-tive method for the diagnosis and treatment of OBFB.