Rhonchus and Valve-Like Sensation as Initial Manifestations of Long-Standing Foreign Body Aspiration: A Case Report
Challenging differential diagnosis, Rare disease
Ivan Cherrez-Ojeda, Miguel Felix, Emanuel Vanegas, Valeria L Mata, Fanny M. Jimenez, Luis Gonzalo Ugarte Fornell
(Universidad Espíritu Santo (Holy Spirit University), Samborondón, Ecuador)
Am J Case Rep 2019; 20:70-73
Foreign body aspiration (FBA) is an unusual medical condition among adults, with most of the cases associated with identifiable risk factors such as significant neurological impairment, drug or alcohol intoxication, and poor dentition. In some cases, however, FBA can present in an asymptomatic way, with estimates that 80% of lodged bodies are not visible on plain chest x-ray, leading to delayed diagnosis and requiring additional imaging techniques and procedures. We report an unusual case of long-standing FBA manifested as rhonchus and a thoracic valve-like sensation in an otherwise healthy man.
CASE REPORT: A 52-year-old man was referred to our office complaining of abnormal respiratory sounds and an unusual valve-like sensation in the chest. According to the patient, both symptoms began approximately 18 months ago, when he was treated for recurrent respiratory infections, but without resolution of such symptoms. After careful initial assessment, a computed tomography scan of the chest was performed, which showed a high-density structure inside the left main bronchus, raising the potential diagnosis of foreign body aspiration. The patient successfully underwent flexible bronchoscopy, and throughout follow-up he remains asymptomatic with no apparent complications.
CONCLUSIONS: Foreign body aspiration remains a rare medical condition among adults. We present an unusual case of long-standing foreign body aspiration manifested as rhonchus and a valve-like sensation in the chest. Detailed clinical examination and proper diagnostic tools should be carefully selected to support a timely diagnosis and prevent late complications of this particular disease.
Keywords: Bronchoscopy, Foreign Bodies, Respiratory Sounds, Tomography, X-Ray Computed