Foreign Bodies In The Bronchi For Prolonged Periods

Categories: FOREIGN BODIES IN THE BRONCHI FOR PROLONGED PERIODS
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The sojourn of an inorganic foreign body in the bronchus for a year or

more is followed by the development of bronchiectasis, pulmonary

abscess, and fibrous changes. The symptoms of tuberculosis may all be

presented, but tubercle bacilli have never been found associated with

any of the many cases that have come to the Bronchoscopic Clinic.* The

history of repeated attacks of malaise, fever, chills, and sweats

lasting f r a few days and terminated by the expulsion of an amount of

foul pus, suggests the intermittent drainage of an abscess cavity, and

special study should be made to eliminate foreign body as the cause of

the condition, in all such cases, whether there is any history of a

foreign body accident or not. Bronchoscopy for diagnosis is to be done

unless the etiology can be definitely proven by other means. In all

cases of chronic chest disease foreign body should be eliminated as a

matter of routine.



* One exception has recently come to the Clinic. 12



The time of aspiration of a foreign body may be unknown, having

possibly occurred in infancy, during narcosis, or the object may even

enter the lower air passages without the patient being aware of the

accident, as happened with a particularly intelligent business man who

unknowingly aspirated the tip of an atomizer while spraying his

throat. In many other cases the accident had been forgotten. In still

others, in spite of the patient's statement of a conviction that the

trouble was due to a foreign body he had aspirated, the physician did

not consider it worthy of sufficient consideration to warrant a

roentgenray examination. It is curious to note the various opinions

held in regard to the gravity of the presence of a bronchial foreign

body. One patient was told by his physician that the presence of a

staple in his bronchus was an impossibility, for he would not have

lived five minutes after the accident. Others consider the presence of

a foreign body in the bronchus as comparatively harmless, in spite of

the repeated reports of invalidism and fatality in the medical

literature of centuries. The older authorities state that all cases of

prolonged bronchial foreign body sojourn died from phthisis

pulmonalis, and it is still the opinion of some practitioners that the

presence of a foreign body in the lung predisposes to the development

of true tuberculosis. With the dissemination of knowledge regarding

the possibility of bronchial foreign body, and the marvellous success

in their removal by bronchoscopy, the cases of prolonged foreign body

sojourn should decrease in number. It should be the recognized rule,

and not the exception, that all chest conditions, acute or chronic,

should have the benefit of roentgenographic study, even apart from the

possibility of foreign body.



Often even with the clear history of foreign-body aspiration, both

patient and physician are deluded by a relatively long period of

quiescence in which no symptoms are apparent. This symptomless

interval is followed sooner or later by ever increasing cough and

expectoration of sputum, finally by bronchiectasis and pulmonary

abscess, chronic sepsis, and invalidism.