Abstract
Chronic pulmonary disease of the elderly caused by frequent aspiration has been recognized in the recent Japanese literatures. We report an elderly case with cerebrovascular disease who had long-term bronchial foreign bodies and had been treated for “asthma” for years. He was taken to an emergency room because of a dyspnea which occurred at breakfast. Fiberscopy showed a bean-like foreign body in his right main bronchus. Using ventilation bronchoscopy, we removed not only this pulse but a piece of fish vertebra from his right main bronchus and another older one coated by granulation tissue from his left superior lobar bronchus. A chest x-ray of this patient showed a diffusely scattered nodular shadow in the right lower lung field; this finding resembled that of diffuse aspiration bronchiolitis (DAB). He showed a multiple brain infarct on MR imaging. A low signal-intensity area in the white matter of the left supra orbital gyrus on T1 weighted image might be related to his characteristic aspiration. We assumed the fine crackle in his lung fields and his continuous productive cough had been caused by frequent aspiration. In the elderly, some patients could have latent aspiration but be incorrectly diagnosed as asthma or other pulmonary diseases. When we meet elderly patients with moist rale and productive cough, we must consider the possibility of chronic pulmonary disease caused by aspiration. There is a need to develop for testing and treating methods for these patients.
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