OUR DIFFERENTIAL DIAGNOSIS:
– Foreign Body
– Infection with extrinsic narrowing: Mycobacterium tuberculosis, Atypical mycobacterium, Fungal infection with lymph mode enlargement, juvenile respiratory papillomatosis
– Infection with intrinsic narrowing: bronchiolitis, cystic fibrosis
– Tumor (benign) hamartoma (versus malignant) neuroblastoma
– Immune mediated: sarcoidosis, immunodeficiency
OUR WORKING DIAGNOSIS:
Foreign Body.
She
was taken to the operating room the same day for a rigid and flexible
bronchoscopy. There was no foreign body seen. The left mainstem bronchus
had exudates and an angry looking mucosa. No biopsy was taken, but 2 bronchial
washings were done. The fluid was particulate. A lesion was noted from
the take-off of the left mainstem bronchus to the left upper lobe bronchus.
The left mainstem was compressed superiorly and posteriorly.
LABORATORY INVESTIGATIONS
– Blood count: WBC 6.4, lymphs=66%, neuts=27%, Platelets=397, Hb= 119. ESR=8– Electrolytes, urea, creatinine normal
– Lactate dehydrogenase, urate, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and albumin were all normal.
– Urine normal.
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