成人气管支气管异物的临床、CT特征及与支气管镜的对照研究

Clinical and CT Features of Tracheobronchial Foreign Body in Adults and CT-Bronchoscopy Correlation

目的探讨成人气管支气管异物(tracheobronchial foreign bodies,TFBs)的临床及CT特征,并将其CT表现与支气管镜对照,以期提高该病的诊断正确率。方法收集我院2014年11月-2021年11月经支气管镜证实的44例成人TFBs的临床及影像学资料,回顾性分析患者临床、CT特征及支气管镜表现。结果(1)异物种类:支气管镜检查共发现4类异物,其中植物食品占比最高(15/44,34.09%),该类异物中又以辣椒皮最为常见(12/44,27.27%),其次为动物食品中的骨性异物(10/44,22.73%)。(2)临床特征:成人TFBs多发生于40-79岁的中老年患者(39/44,88.64%);男性略多于女性(1.2:1);70.45%(31/44)的患者无明确异物吸入史,最常见的临床症状为咳嗽(43/44,97.73%),其次为咳痰(31/44,70.45%),88.64%(39/44)的患者白细胞计数正常;(3)CT表现:右肺下叶支气管是TFBs最常见部位(18/44,40.91%);多数异物表现为高密度影(33/44,75.00%)且形态不规则(22/33,66.67%);继发征象中以阻塞性肺炎最常见(37/44,84.09%),其次为阻塞性肺不张(19/44,43.18%)、支气管扩张伴黏液栓塞(16/44,36.36%)及支气管腔内强化软组织影(15/44,34.09%);(4)CT与支气管镜对照:32例已知异物中,骨性异物、牙齿及金属异物在CT上表现为高密度影(17/32,53.13%),植物食品既可呈高密度影(7/32,21.88%),亦可呈等密度影(8/32,25.00%);16例支气管扩张伴黏液栓塞镜下表现为支气管腔内较多脓性分泌物;15例支气管腔内强化软组织影镜下表现为异物周围肉芽组织增生。结论成人TFBs好发于60-79岁老年人,临床症状多为咳嗽且无明确异物吸入史,CT上以右肺下叶多见,常表现为支气管腔内不规则高密度影伴阻塞性肺炎、阻塞性肺不张及支气管黏液栓塞,熟悉这些表现有助于该病的早期、正确诊断,改善患者预后。

Objective To investigate the clinical and CT features of tracheobronchial foreign bodies(TFBs)in adults and compare the CT features with bronchoscopy findings in order to improve the diagnostic accuracy of TFBs.Methods A total of 44 adult patients with TFBs confirmed by bronchoscopy in our hospital from November 2014 to November 2021 were included,and their clinical features,CT signs and bronchoscopy findings were retrospectively analyzed.Results(1)Types of TFBs:four types of TFBs were found by bronchoscopy.Plant food accounted for the highest proportion(15/44,34.09%),of which pepper skin was the most common(12/44,27.27%),followed by bone foreign bodies in animal food(10/44,22.73%).(2)Clinical features:the TFBs of adult were more frequent in patients aged from 40 to 79 years(39/44,88.64%),and men were slightly more common than women(1.2:1);70.45%(31/44)patients had not clear history of foreign body inhalation and 88.64%(39/44)patients exhibited a normal white blood cell count;the most common clinical symptom was cough(43/44,97.73%),followed by sputum(31/44,70.45%).(3)CT signs:TFBs were more common in the right lower lobe bronchus(18/44,40.91%)and most of them presented as high density(33/44,75.00%)and irregular morphology(22/33,66.67%);among the secondary CT signs,obstructive pneumonia was the most common(37/44,84.09%),followed by obstructive atelectasis(19/44,43.18%),bronchial mucus embolism(16/44,36.36%),and intra bronchial enhancement of soft tissue(15/44,34.09%).(4)Bronchoscopy findings in relation to CT features:among 32 known TFBs,bone,tooth and metal foreign bodies presented as high density(17/32,53.13%),and plant food presented as high density(7/32,21.88%)or equal density shadow(8/32,25%%%);bronchial mucus embolism on CT in 16 patients was related to purulent secretions in the lumen under bronchoscopy,and enhanced soft tissue within bronchial lumen on CT in 15 patients corresponded to proliferation of granulation tissue around foreign body under bronchoscopy.Conclusion Adult TFBs are more common in the elder aged 60-79 years.The main clinical features of patients are cough and no clear history of foreign body inhalation.The mostly CT findings are location in right lower lobe of lung,manifested as regular high-density shadow in the bronchial lumen with obstructive pneumonia,obstructive atelectasis,and bronchial mucus embolism.Being familiar with these manifestations may contribute to the early diagnosis of the disease and improve the prognosis of those patients.