Nose Stud Screw Aspiration- A Tiny Foreign Body with Potentially Huge Disaster: 2 Cases with Different Ways of Retrieval

( Khai Lip Ng ),( Nai Chien Huan ),( Mona Zaria Nasaruddin ),( Noorul Afidza Muhammad ),( Ummi Nadira Daut ),( Jamalul Azizi Abdul Rahaman ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Nose piercing is traditionally a common practice among women of Indian ancestry. The practice of nose piercing has gained significant popularity in various communities worldwide for the past decade. The practice can potentially lead to aspiration of nose jewelleries such as screws of nose studs. Aspiration of small foreign bodies can be silent although potentially serious and life-threatening sequelae can happen in long term. Herein, we present 2 patients of Indian ancestry who aspirated screw of nose studs with different Methods of retrieval. Both of the patients are assymptomatic and foriegn body was found incidentally on chest radiograph. They could not recall the timing of aspiration of foreign body, which is nose stud screw in this case. Small foriegn body such the nose stud screw could potentially dislodge into subsegmental bronchi, rendering retrieval extermely difficult. The 2 cases are presented to show that the same type of foreign body can be retrieved easily if it remains in the main bronchus simply with flexible bronchoscope and grasping forceps, or require various method such as retrieval basket, magnet etc under rigid bronchoscopy. Small foriegn body could lead to serious complications such as severe infection, or massive hemoptysis if left in the airway. While aspiration of scarf pins among Muslim girls and ladies who wears a hijab, called the “hijab syndrome” have been extensively reported, there is a paucity of publications regarding “nosestud syndrome” among Indian communities. To the best of our knowledge, this is the first case report delineating aspiration of screw of nose studs and their retrieval Methods. The incidence and burden of nose stud aspiration remains unknown, and is likely underreported and underrecognized, as patients can remain asymptomatic. We hope that our case report can help to increase awareness and understanding of potential dangers of nose piercing.

Successful Treatment of Excessive Dynamic Airway Collapse with Noninvasive Positive Pressure Ventilation - A Case Report

( Khai Lip Ng ),( Nai Chien Huan ),( Mona Zaria Nasaruddin ),( Noorul Afidza Muhammad ),( Ummi Nadira Daut ),( Jamalul Azizi Abdul Rahaman ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Introduction Excessive central airway collapse (ECAC) can present as unexplained dyspnea, wheezing or stridor. ECAC can easily be misdiagnosed as bronchial asthma, COPD and heart failure. ECAC can occur as a result of tracheobronchomalacia or excessive dynamic airway collapse (EDAC).There are various Methods of diagnosis and treatment of ECAC but it has to be tailored according patient’s circumstances. Case Report We present a 75-year-old lady with multiple comorbidities including vascular dementia who was brought in by her daughter after she noticed that her mother had wheezing, shortness of breath and reduced effort tolerance for the past 2 months. Her symptoms were worse on exertion and during sleep. She was given bronchodilator without any improvements. She was overweight and her STOPBANG score of 6. CT thorax showed posterior indentation of mid distal trachea with significant luminal narrowing. Unfortunately, she couldn’t comply to dynamic chest CT test due to vascular dementia. Flexible bronchoscopy done under conscious sedation confirmed almost total occlusion of both left and right main bronchus together with narrowing of tracheal diameter of more than 80% that were present only during expiration. Partial sleep study done showed evidence of OSA with an AHI of 58/hour, and a lowest oxygen saturation at 51%. Both her EDAC and OSA was treated successfully with a CPAP machine. On subsequent follow up, her daughter reported that her symptoms has resolved together with improvements in her effort tolerance. Discussion and Conclusion There are various Methods to diagnose and manage a patient with EDAC, some of which are invasive and thus are risky for elderly patients with multiple co-morbidities. Choices of investigations and treatment for this condition need to be tailored according to patient’s need and circumstances. CPAP in this case was given without real time titration under flexible bronchoscopy with success in her case.

Haemorrhage Post Biopsy of a Bronchial Carcinoid

( Sangeta Vadivelu ),( Kho Sze Shyang ),( Wong Soo Fen ),( Jamalul Azizi Abdul Rahaman ),( Mona Zaria Nasaruddin ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Bronchial carcinoid tumours are rare, indolent, malignant neuroendocrine tumours derived from Kulchitsky cells and are not related to smoking. As these tumours can be asymptomatic or present with non specific symptoms, a high index of suspicion is essential to make an early diagnosis which determines the prognosis. Surgery is curative and remains the mainstay of treatment. Case presentation A 41-year-old female with no Background medical illness first presented with a spontaneous left sided pneumothorax requiring a chest tube insertion. High-resolution CT (HRCT) thorax detected an incidental solitary pulmonary nodule. Bronchoscopy revealed a smooth round tumour sitting at the ostium of the basal right lower lobe bronchus. Endobronchial biopsy was complicated with massive bleeding requiring emergency exploration via rigid bronchoscopy. Multiple attempts to secure haemostasis using Watanabe spigot and argon plasma coagulation failed. She was intubated with a double lumen tube to isolate the healthy left lung. An urgent CT pulmonary angiogram (CTA) was performed to look for collaterals and feasibility of embolization, but no collaterals were seen. She was then referred to the cardiothoracic surgeon for an emergency right lobectomy. Histopathological examination revealed typical carcinoid tumour. She was discharged from the hospital in a stable condition. Discussion Bronchial carcinoids embryologically originate from the foregut and patients rarely present with features suggestive of carcinoid syndrome and crisis. Mostly are asymptomatic resulting in late presentation and diagnosis. Majority of the typical carcinoids are centrally located and may present with obstructive symptoms and recurrent pneumonia. Bronchoscopists may face massive bleeding following endobronchial biopsy in bronchial carcinoids. Conclusion Massive bleeding after endobronchial biopsy can occur and therefore the bronchoscopist should have anaesthesia, interventional radiology, and cardiothoracic support to handle this complication. Using tumour markers may obviate the need for biopsy in typical bronchial carcinoids to prevent massive bleeding after endobronchial biopsy.

Pulmonary Mucormycosis Masquerading as Endobronchial Tumour in an Immunocompetent Pregnant Young Lady

( Khai Lip Ng ),( Nai-chien Huan ),( Ummi Nadira Daut ),( Sanusi Zulkifli ),( Noorul Afidza Muhammad ),( Mona Zaria Nasaruddin ),( Jamalul Azizi Abdul Rahaman ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Introduction Pulmonary murcomycosis is an uncommon fungal infection that typically affects immunocompromised patients. Rarely, it can affect immunocompetent patients, presenting as endobronchial lesions mimicking lung malignancy. Herein we report a patient with pulmonary murcomycosis with favourable treatment outcome via a multimodality approach utilizing antifungal agents and endobronchial intervention. Case Report A 31-year-old lady with no prior medical condition presented with a 3-month history of cough associated with weight loss of more than 5 kilograms and occasional haemoptysis (blood streaks in sputum). Chest radiograph and computed tomography demonstrated mediastinal lymphadenopathy and left hilar mass with infiltration into left main bronchus. Flexible bronchoscopy revealed presence of an endobronchial mass occluding the left main bronchus. Her tuberculosis workup, diabetes screening and retroviral tests were all negative but she was found to be pregnant at 6weeks. She was subsequently scheduled for rigid bronchoscopy and debulking of endobronchial mass. To our surprise, histopathological examination revealed inflamed tissue with presence of fungal organism which was subsequently confirmed to be Rhizopus microspores via fungal polymerase-chain-reaction. With the diagnosis in mind, she was promptly treated with intravenous amphotericin-B for a total of 2 weeks in duration, which was accompanied by clinical improvements and total radiological resolution. Amphotericin-B was chosen instead of other anti-fungal agents after taking into account of her pregnancy status. Conclusion Murcomycosis should be considered among young patients who presented with endobronchial lesion. Rapidly progressing nature of the disease warrants early diagnosis and treatment to ensure a better clinical outcome.