Post on 04-May-2018
CASE REPORTCytology and histology of a potential life-threatening airway injury
Vanessa HenriquesLucília Monteiro
Clinical History
• 90 years-old male
• Bedridden
• Previous thoracic trauma with lung perforation
Presented to the ER with:
Dyspnea, thoracalgia, vomiting.
Lymphocytosis
Elevated RCP Chest X-ray on admission: Right hilum and lower lobe opacities.
Chest X-ray on 10th day after admission:Right hilum and lower lobe hypotransparency.
Chest CT Scan: Right lower lobecollapse and pleural effusion.
Day 10 of Antibiotics
Right main bronchus: slightly elevated, yellow and friable with easy bleeding.
Bronchoscopy
Right bronchus branching: yellowish and necrotic aspect.
Fibrillary and
Birefringent deposits
Bronchial Biopsy
Hyphae morphologicallysuggestive of Candidaspp.
• 32 cases published (mean age of 68 y-o)
• > 50% patients did not realise the aspiration event
• Clinical presentation commonly non-specific: 8 haemoptysis 2 fatal
• Diagnosis relies on biopsy and medication history
• No foreign body identification Chemical burn!
Literature Review
CoughHaemoptysisChest pain
Persistent coughDyspnoeaAsymptomatic
Friable mucosaYellowish-brown colorHemorrhage
Bronchial stenosis
CLINICAL PRESENTATION
BRONCHOSCOPY
CYTOLOGYBIOPSY
Necrotic mucosaGolden-brown fibrils Squamous metaplasia
Granulation tissueIron depositsFibrous tissue
Literature Review
ACUTE PHASEDays / weeks
CHRONIC PHASE> 2 Months / Year