Nhân một trường hợp lâm sàng hiếm gặp: tràn dịch màng phổi do dị vật đường thở

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Tác giả: Thế Hoàng Ngô, Minh Vương Trần, Thị Tố Uyên Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.199

Bộ sưu tập: Metadata

ID: 339305

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- Đặt vấn đề: Chúng tôi báo cáo một trường hợp lâm sàng hiếm gặp: bệnh nhân tràn dịch màng phổi do dị vật phế quản. Thông qua việc từng bước loại trừ các nguyên nhân gây tràn dịch màng phổi dịch tiết thường gặp, dựa trên phương tiện sẵn có tại Bệnh viện Thống Nhất, chúng tôi muốn nhấn mạnh vai trò của nội soi phế quản ống mềm trong phát hiện và xử trí sớm các trường hợp dị vật phế quản không điển hình ở người lớn tuổi.- Báo cáo trường hợp: Bệnh nhân nam 80 tuổi, tình cờ phát hiện tràn dịch màng phổi phải trên phim Xquang ngực thẳng khi khám xuất cảnh. Quá trình hỏi bệnh sử, thăm khám, xét nghiệm dịch màng phổi, chụp cắt lớp vi tính lồng ngực và sinh thiết màng phổi mù không chỉ ra được nguyên nhân gây tràn dịch màng phổi. Kết quả xét nghiệm giúp loại trừ tràn dịch màng phổi do lao và chưa có bằng chứng của tràn dịch màng phổi ác tính. Nội soi phế quản ống mềm được chỉ định, ghi nhận có dị vật hình hạt đậu gây bít lòng phế quản phân thuỳ B9, viêm phù nề niêm mạc phế quản. Sau khi gắp bỏ dị vật, lâm sàng bệnh nhân tiến triển tốt, các chỉ dấu viêm trở về bình thường. Tuy nhiên, bệnh nhân vẫn còn tình trạng tràn dịch màng phổi lượng ít nghi do “trapped lung”, hậu quả của chẩn đoán và xử trí muộn.- Kết luận: Dị vật đường thở có thể gặp ở người lớn tuổi với biểu hiện không điển hình và bệnh sử thường bị bỏ sót. Ngay cả khi chụp cắt lớp vi tính lồng ngực không chẩn đoán được dị vật đường thở, bác sĩ lâm sàng nên nghi ngờ nếu bệnh nhân có các triệu chứng hô hấp bao gồm: ho, khạc đàm, ho ra máu, khó thở, đau ngực hoặc tràn dịch, tràn khí màng phổi không giải thích được nguyên nhân hoặc không đáp ứng điều trị ban đầu. Nội soi phế quản ống mềm là phương pháp đơn giản, an toàn và hữu ích trong chẩn đoán và xử trí dị vật đường thở.Abstract- Background: We report a rare clinical case: a patient with pleural effusion due to a bronchial foreign body. Step by step, we excluded the common causes of exudative pleural effusion, based on available condition at Thong Nhat Hospital. By that, we emphasize the role of flexible bronchoscopy in early detection and treatment of atypical bronchial foreign bodies in the elderly.- Case presentation: An 80 - year - old male patient was incidentally discovered a right pleural effusion on a straight chest x-ray on export health check. The information from history, physical examination, pleural fluid testing, chest computed tomography, and blind pleural biopsy failed to reveal the cause of the pleural effusion. Tuberculous pleural effusion was excluded and there was no evidence of malignant pleural effusion. Flexible bronchoscopy is indicated, there is a bean - shaped foreign body causing bronchial obstruction in segment B9, inflammation and edema of the bronchial mucosa. After removing the foreign body, the patient’s clinical status resolved, the inflammatory markers returned to normal. However, the patient still has a small amount of pleural effusion, suspected of being “trapped lung”, a consequence of late diagnosis and management.- Conclusion: Aspiration of a foreign body may occur in the elderly with an atypical presentation and lack of history information. This condition should be suspected if the patient has unexplained respiratory symptoms or is not responding to initial treatment, including cough, sputum production, hemoptysis, dyspnea, chest pain, or pleural effusion. Flexible bronchoscopy is a simple, safe and effective method in the diagnosis and management of foreign body aspiration. DOI: 10.59715/pntjmp.2.2.25

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