천식과 혼돈되어 진단이 지연된 기관지 내 이물 1예
Delayed diagnosis of an endobronchial foreign body confused with bronchial asthma
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초록
기관지 내 이물 흡인은 장기간 지속되는 기침, 가래, 발열 등의 비특이적 증상만을 보일 수 있고, 특히 환자가 인지하지 못하는 경우, 반복적인 폐렴, 육아종 형성 및 기관지 변형 등의 합병증으로 이어질 수 있다. 따라서 임상가는 기관지 내 이물 흡인의 임상적 특징을 이해하고, 치료에 잘 반응하지 않는 만성 기침이나, 천식, 재발성 폐렴환자에서 기관지 이물 흡인을 감별진단의 범주에 포함시키고 흉부 전산화 단층 촬영 및 기관지 내시경 등을 조기에 고려하는 것이 바람직하겠다. 저자들은 폐렴이 반복되고, 만성적인 기침의 원인이 치료에 잘 반응하지 않는 천식 때문으로 판단했었던 환자에서 기관지 내시경 검사를 통해 기도 이물을 진단하고 제거한 증례를 경험하여 이를 보고하는 바이다.
Abstract
Tracheobronchial foreign bodies can remain undetected for months, or even years, and often present as chronic respiratory symptoms, such as an intractable cough. We report the case of a 51-year-old woman with a cough for over 3 years and hemoptysis for 2 weeks. She had been treated for asthma for the previous 3 years because of her cough, wheeze, and positive bronchodilator response. Her symptoms waxed and waned. Her chest X-ray showed a new mass-like opacity and ill-defined infiltration in the right lower lobe. Computed tomography showed a 2.5-cm mass-like lesion in the right infrahilar area. At fiberoptic bronchoscopic, a solid foreign body was found in the right lower lobe bronchus and was identified as a fish bone. Tracheobronchial foreign body aspiration should always be considered in the differential diagnoses of radiographic lesions or chronic respiratory symptoms that cannot be easily explained.
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