PDF(Pubmed)
Abstract：
Granuloma formation is generally correlated with infection. Pulmonary granulomas caused by foreign bodies aspiration are uncommon. The clinical and radiologic features of such cases often lack specificity, which makes it difficult to distinguish from malignancy. Aspiration is usually not considered in the differential diagnosis of patients presenting with mass-like abnormalities on chest imaging. Occult aspiration history, diverse clinical manifestations, atypical imaging findings, and limited availability of pathogen detection techniques make the precise diagnosis a substantial challenge. Herein, we describe an older patient presenting with chest pain and worrisome lung masses/nodules that proved to be pulmonary granulomas caused by foreign matters aspiration. In addition, the patient developed Mendelson syndrome due to acute macroaspiration. Lung tissue metagenomics next-generation sequencing (mNGS) revealed Streptococcus intermedius, a normal flora of the oropharynx. The aim of this case was to underscore the importance of considering aspiration as a potential differential diagnosis of patients presenting with pulmonary granulomas, especially in patients with recurrent pneumonia or predisposing factors. In addition, mNGS act as a potential, rapid, and effective technique for diagnosing aspiration-related syndrome, showing satisfactory performance in identifying pathogens.
摘要：
肉芽肿的形成通常与感染有关。由异物吸入引起的肺肉芽肿并不常见。此类病例的临床和放射学特征往往缺乏特异性，这使得很难区分恶性肿瘤。在胸部影像学表现为肿块样异常的患者的鉴别诊断中，通常不考虑误吸。隐秘的抽吸历史，不同的临床表现，非典型影像学发现，病原体检测技术的有限可用性使精确诊断成为重大挑战。在这里，我们描述了一名老年患者，表现为胸痛和令人担忧的肺部肿块/结节，被证明是由异物吸入引起的肺肉芽肿。此外,患者因急性宏观抽吸而发展为Mendelson综合征。肺组织宏基因组学下一代测序（mNGS）揭示了中间链球菌，口咽部的正常菌群。此病例的目的是强调将误吸作为肺肉芽肿患者的潜在鉴别诊断的重要性。特别是在反复肺炎或诱发因素的患者中。此外,MNGS作为一种潜力，快速,以及诊断吸入相关综合征的有效技术，在鉴定病原体方面表现出令人满意的性能。
