45-year-old woman with progressive difficulty in breathing over two days. Brought to casualty in extreme distress. No breath sounds were heard on the left side of the chest on clinical examination.
Bedside chest radiograph showed a completely collapsed left lung with homogeneous soft tissue density in the left hemithorax. No mediastinal shift was evident. On questioning, it was found that the patient had a betel chewing habit and the problem seemed to have begun after she went to sleep while chewing some betel nuts.
CT scan of the Thorax (without intravenous contrast) was done. The initial scanogram (below) showed the same findings as the bedside CXR.
Coronal reformatted CT images in lung and mediastinal (soft tissue) window settings confirm the total collapse of left lung. No pleural effusion is seen.
…
Oblique coronal minimal intensity projection (MinIP) and MPR image of the central airways shows a complete obstruction in the distal Left Main Bronchus with air bronchogram in the lower lobe of the collapsed left lung.
…
The same oblique coronal reformatted image, viewed in soft tissue (mediastinal) window setting shows an ovoid soft tissue density foreign body obstructing the distal Left Main Bronchus just proximal to its bifurcation. Most likely to be a betel nut.
The patient’s family did not consent to an emergency bronchoscopy and foreign body removal. They wanted to take her to a larger hospital in a bigger city nearby, so I do not know if it turned out to be a betel nut.
Here is a similar case of a foreign body obstructing the airway in a child. A true Drama In Real Life moment that happened a couple of years ago, that I blogged about.
Start Slide Show with PicLens Lite
Impressive images!