Gopal Lung care centre, The Interventional Pulmonology unit

15/03/2025

Bronchoscopy in Aspiration Pneumonia: A Life-Saving Intervention

Case Summary

A middle-aged man with no comorbidities accidentally fell into a drainage canal and aspirated contaminated water. He remained conscious and clinically stable but developed a cough with muddy sputum. CT chest revealed few infiltrates, prompting bronchoscopy for bronchial toileting.

Bronchoscopic Findings & Intervention

Purulent secretions were observed in both bronchi.

Surprisingly, a metallic foreign body was found lodged in the left main bronchus.

The foreign body was successfully extracted, and bronchial toilet was performed to clear secretions.

Key Learnings: The Critical Role of Early Bronchoscopy

1. Imaging Often Underestimates Severity

CT scans showed only mild infiltrates, but bronchoscopy revealed significant airway contamination and a foreign body.

This highlights how radiological findings do not always correlate with the true extent of airway involvement in aspiration pneumonia.

2. Bronchoscopy as Both a Diagnostic and Therapeutic Tool

Early bronchial toilet helps:

Remove infected secretions

Neutralize acidic aspirates

Reduce inflammation and prevent lung injury

Foreign body removal prevents complications like post-obstructive pneumonia, lung abscess, or airway obstruction.

3. Early Intervention Improves Outcomes

In cases of aspiration pneumonia with a significant aspiration event or persistent symptoms, bronchoscopy should not be delayed.

It is not just a diagnostic tool but a definitive treatment, effectively preventing further complications.

Conclusion

This case underscores the life-saving potential of early bronchoscopy in aspiration pneumonia. It should be considered the treatment of choice in suspected foreign body aspiration, persistent symptoms, or severe aspiration events. Early intervention can significantly reduce lung injury, improve outcomes, and prevent complications.

15/03/2025

19/02/2025

A tale of an isolated lymphnode (10R)

25/01/2025

Case Report: Successful Management of Airway Foreign Body in an 8-Year-Old Child

Patient Details:

Age: 8 years

Presentation: Persistent cough, fever, and chest pain following suspected foreign body aspiration.

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Clinical History:
The child aspirated a pen cap into the airway a few days prior to presenting with symptoms. Evaluation revealed signs of right lung collapse on imaging studies, raising suspicion of an impacted airway foreign body in the right bronchus.

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Investigations:

Imaging Studies: Chest X-ray and/or CT revealed collapse of the right lung and a suspicious foreign body in the bronchus.

Fiberoptic Bronchoscopy: Confirmed the presence of an impacted pen cap in the right bronchus.

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Management:

1. Initial Intervention:

Fiberoptic Bronchoscopy:

Attempted to retrieve the foreign body but was unsuccessful due to its impacted nature.

2. Definitive Intervention:

Rigid Bronchoscopy:

The pen cap was successfully visualized, captured, and extracted under general anesthesia.

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Outcome:
The procedure was completed without complications, and the child's symptoms improved significantly post-intervention. Follow-up imaging confirmed re-expansion of the right lung with no residual complications.

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Discussion:
Foreign body aspiration is a common pediatric emergency requiring prompt diagnosis and management. While fiberoptic bronchoscopy is a useful diagnostic tool, rigid bronchoscopy remains the gold standard for retrieval of impacted foreign bodies, particularly in cases involving larger objects or airway compromise.

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Conclusion:
This case highlights the importance of timely diagnosis and the role of a multidisciplinary approach in managing airway foreign bodies. The successful extraction of the pen cap using rigid bronchoscopy demonstrates its superiority in managing complex cases of foreign body aspiration.

21/11/2024

Tracheal tumor (Adenoid cystic Carcinoma) presented as acute respiratory failure. Bronchoscopic excision of the tumor done under conscious sedation and discharged on the same day.

13/08/2024

"I am deeply honored to be recognized by Outlook India as one of South India's Best Pulmonologists for the second consecutive year in 2024. This achievement would not have been possible without the unwavering support of my well-wishers, the trust of my patients, and the dedication of my exceptional team. Thank you all for being an integral part of this journey."

31/07/2024

Thoracoscopy - Adhesionlysis and Decortication - Multiloculated empyema management.
Dr M S Gopala krsihna
Lung Care Centre
Aayush Hospital
Vijayawada.

21/07/2024

Vocal cord nodules - Bronchoscopic excision
Dr M S Gopala krsihna
Lung Care Centre
Aayush Hospital
Vijayawada

20/06/2024

Post intubation Tracheal Stenosis. Bronchoscopic dilatation with EC knife and CRE Balloon.

23/05/2024

Bronchoscopic release of Vocal Cord Synechiae.
Lung Care Centre.

24/04/2024

Vocal cord nodules - Bronchoscopic excision

03/03/2024

Bronchoscopic excision of the right vocal cord growth done under local anesthesia.