Producción científica2020· Scientific Archives of Dental Sciences
Endo-Periodontal Lesion Treatment: Keep or Remove. A Case Report
AutoresPallarés-Serrano AI, Albert-López MJ, Javier A Bardají
Por qué importa
Aunque este caso clínico no aborda directamente la práctica odontológica, ilustra las complejidades de las aspiraciones de cuerpos extraños, que pueden simular otras patologías y complicarse con infecciones crónicas o tejido de granulación. La dificultad diagnóstica, incluso con técnicas avanzadas como la tomografía computarizada, subraya la importancia de una historia clínica detallada y un alto índice de sospecha. En odontología, aunque la aspiración de materiales dentales es menos común que en pediatría, la comprensión de cómo cuerpos extraños, especialmente los radiolúcidos, pueden causar obstrucción y reacciones inflamatorias prolongadas es relevante. La gestión de estos casos puede requerir intervenciones quirúrgicas complejas cuando los tratamientos conservadores o endoscópicos fallan, lo que resalta la necesidad de considerar todas las posibles complicaciones de la aspiración o ingestión de cuerpos extraños, incluso los de origen orgánico.
Tracheobronchial foreign body aspiration (FBA) is potentially life-threatening. In adults, delayed diagnosis may occur because symptoms are nonspecific and organic foreign bodies can be radiolucent, leading to recurrent infection, granulation tissue, and surgical resection. A 46-year-old Arab man with hypertrophic cardiomyopathy and hypertension presented with fever, productive cough, and grade II dyspnea 15 months after accidental pea aspiration. Chest computed tomography (CT) demonstrated a focal basal right lower-lobe mass-like consolidation, corresponding to the surgically treated basal segments, without a definite radiopaque intraluminal foreign body. Flexible bronchoscopy achieved only partial removal, and histopathology confirmed plant material with nonspecific chronic inflammation. Despite conservative treatment, he deteriorated with foul-smelling purulent sputum and persistent inflammation. Because of failed conservative/endoscopic management, bronchial strictures, and vegetative inflammatory lesions, he underwent right lower-lobe basal segmentectomy via thoracotomy. Surgery revealed marked induration, consolidation, and a purulent collection. Final pathology showed chronic suppurative inflammation with lymphoid follicles and purulent material, plus a 1.3-cm sclerosing nodule with papillary formations; immunohistochemical evaluation was requested to further exclude an associated neoplastic process. At 2-week follow-up, he improved clinically, and chest radiography showed no residual or recurrent focal mass-like consolidation. Adult FBA may mimic malignancy or chronic infection. CT is essential for identifying secondary postobstructive changes, although the foreign body may not be directly visible. Delayed presentation increases the risk of granulation, infection, and failed bronchoscopic retrieval. Delayed organic FBA should be considered in persistent focal lower-lobe consolidation; early CT and bronchoscopy may prevent complications and surgery.
