An Occult Case of Worsening Dyspnoea in Adult Affected by Anatomic Abnormalities of Oral Cavity: A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 2
Abstract
Aspiration of foreign bodies (FBs) occurs frequently in children and most of all occurs in children of about three years old [1]. However, FB aspiration can occur in adults and elderly people [2] but the real incidence is not known. The nature of foreign bodies aspiration in adult population is usually related to eating habits and the clinical presentation depends on the site of FB impaction. Bronchial aspiration usually presents as an acute event, but sometimes it may manifest itself insidiously making diagnosis very difficult. Since the improvement of both rigid and flexible bronchoscopes, the survival is good and morbidity is low [3]. Here we report a case of patient affected by tongue cancer who inhaled a 6 cm foreign alimental body and was admitted to the emergency department two day after the aspiration presenting non-specific symptoms.A 65-old Italian man was admitted at 4 pm to the emergency department presenting worsening dyspnoea developed two days before during the normal daily activities. Significant alcoholism and tobacco smoking story was noted. The past medical history consisted of anxiety and depression, epidermoid tongue cancer treated by pull through operation, extended right cervical lymphadenectomy and temporary tracheotomy in 2011 (pT1N0G3), chronic cerebral vasculopathy and pace-maker implantation for trifascicular block. General examination revealed a mild cooperative and pale male. The oral cavity presented the surgical sign of previous partial tongue resection and neck examination showed the signs of previous tracheotomy (Figure 1). Respiratory examination revealed patient affected by dyspnoea and reduction of breath sounds in the left hemithorax. Cardiovascular auscultation revealed arrhythmic heart sounds. Abdominal examination was unremarkable. The patient presented altered vital signs: artery pressure of 140/80 mmHg; arrhythmic pulse of 112 bpm; arterial oxygen saturation of of 74% a/a. He was not febrile. Abnormal laboratory investigations included: white blood cells 17.1 x103/uL (4.00-10.00); D-Dimer 352 ng/ml (< 278); Glycemia 197 mg/dl (70-110); NT-pro BNP 2741 ng/L (<450); cardiac T troponin 21.12 ng/L (0-14); reactive C protein (RCP) 94.1 mg/L (0-5). Electrocardiogram showed atrial fibrillation. Chest X-ray (CXR) was performed in supine position and demonstrated complete opacification of the left hemithorax with shift of cardiac structures to the left side, hyperexpansion of the right lung, no estimable cardiac imaging, no pleural effusion on the right, pace-maker device on the left side (Figure 2). The arterial blood gas analysis showed: pH 7.52; PaCO2 24.1 mmHg; PaO2 34.6 mmHg; arterial oxygen saturation of 73.9%; lactates 3.1 mmol/L; HCO3- 20.1 mmol/L; BEecf -3.0 mmol/L; PaO2/FiO2 165.7 mmHg. Antibiotic prophylaxis (Ceftriaxone 1 g and Metronidazole 1500 mg) and oxygen therapy (FiO2 1) were given.
Authors and Affiliations
Pierluigi Gucciardino, Saverio Paventi, Mario Bosco
Keywords
Related Articles
- EP ID EP594437
- DOI 10.26717/BJSTR.2019.13.002387
- Views 171
- Downloads 0
Near-Infrared Spectroscopy In atypical Depression: A Diagnostic Possibility
Optical topography is a non-invasive device with high resolution for imaging hemodynamic changes to assess brain function, using near-infrared spectroscopy (NIRS). In Japan, the cost of this technique can be covered by h...
Strategies for Remediating Environmental Pollution, and Applicable Indicators for Identifying them: Mini Review
Toxic chemicals are mostly released into the air, water, and soil due to anthropogenic activities or natural processes. These chemicals can be classified as organic or inorganic pollutants that can cause serious environm...
Cell Renewal and Regeneration
Cell or tissue renewal and regeneration are the two main developmental requirements of adult organisms. Both processes have as starting point a population of stem cells, normally located in a specific en...
Newly Diagnosed With Prostate Cancer? - A Mentor/Patient Discussion
Please recognize that I am not a Medical Doctor. Rather, as a medical detective, I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 1992. I have dedicated my r...
Desmoplastic Medulloblastoma with Atypical Presentation in an Adult Patient: A Case Report
Medulloblastomas are usually in desmoplastic type in adults. This type of medulloblastoma is generally a well-circumscribed tumor. In this report we present an adult patient with desmoplastic medulloblastoma with atypica...