Cashew nut fragments stuck in lungs for more than 2 months, forcing old woman to use ventilator

Recently, Tam Anh General Hospital in Ho Chi Minh City received a patient, Ms. NTM (70 years old, Ho Chi Minh City) in the emergency room with difficulty breathing, fever and phlegm cough. Accordingly, when she saw a lot of coughing, wheezing, and difficulty breathing, she immediately bought medicine to take. After 1 month of taking the medicine without improvement, she had a fever, coughed a lot, and had to use a ventilator at home.

Immediately, Dr. Phan Tuan Trong put a stethoscope on the patient's lungs to check. Normally, when coughing, both the left and right lungs make a whistling sound, but when Ms. M. coughed, she only heard a whistling sound in the right lung. Suspecting that the patient had a foreign object in her lungs, Dr. Trong ordered Ms. M. to have a chest CT scan and blood test.

Ms. M's right lung area, seen on the CT Scanner results, has a large opaque area compared to the left lung. (Photo provided by the hospital).

Consistent with Dr. Trong's diagnosis, the CT scan results showed that the patient's right lung had a large inflammatory patch, a small amount of effusion, and a complete blockage of the right bronchial branch. Blood tests also showed high white blood cell counts and slightly reduced blood oxygen, which was consistent with a lung infection.

The pus culture results showed that the pneumonia was caused by Staphylococcus Aureus, and the patient was given specific antibiotics to treat this type of bacteria. The patient was also given anti-inflammatory drugs, cough suppressants, and oxygen to treat pneumonia and pleural effusion, and waited for his condition to stabilize so he could undergo bronchoscopy to remove the foreign body.

After 2 days of stable treatment, the doctors used a flexible endoscope to enter the patient's right bronchus and noted that it was full of phlegm and pus. The doctor sucked all the fluid out of the lung and continued to insert the endoscope down to the lower lobe bronchus (near the bottom of the lung). A small piece of white, about 1cm long, lay horizontally in the bronchus, the surrounding edges cutting into the bronchial wall causing inflammation. The doctor gently removed the foreign object, a piece of cashew nut, from the patient's lung.

Dr. Phan Tuan Trong said that in adults, the largest part of the trachea is 1.5 - 2cm in size, depending on the body and gender. The younger the child, the smaller the trachea. Therefore, any object smaller than the diameter of the trachea is completely capable of falling into it.

Image of foreign object removed from the bronchus. (Photo by BVCC).

When a foreign object enters the trachea, the body will have a cough reflex (called intrusion syndrome) to expel the foreign object from the airway. If the foreign object is not expelled, it will get stuck in the bronchus, causing obstruction of the bronchus or bronchial branches. If the patient has a large foreign object blocking the airway, he or she will cough, turn purple, sweat, and roll his or her eyes and nose. If the patient does not receive timely emergency care, it will lead to suffocation and death.

In cases where the foreign object does not obstruct the airway but gets stuck in the lungs, the patient will have symptoms including: mild chest pain, difficulty breathing, cough with phlegm, fatigue, and fever. Foreign objects in the lungs for a long time can cause pneumonia, abscesses, pleural effusion, and respiratory failure.

To prevent foreign objects from falling into the airways, doctors recommend eating slowly and chewing thoroughly, avoiding talking, laughing, watching movies, and lying down while eating... In particular, children should avoid playing while eating. Do not give children foods in the form of grains, small pieces, or round pieces. For children and people who have had a stroke that paralyzed the nerves in the throat area, food should be cooked soft and crushed.

Le Trang

Source: https://www.congluan.vn/manh-hat-dieu-nam-trong-phoi-hon-2-thang-khien-cu-ba-phai-dung-may-tro-tho-post267239.html