engleski

Undiagnosed mucoid impaction in asthma as an indication for thoracic surgery

Background: Term “mucoid impaction of the bronchi” is known since year 1951. Altered viscoelastic properties of asthmatic mucus results with impaired mucus transport rates that together with inhibited ciliary function lead to endobronchial obstruction. Mucoid impactions present a diagnostic challenge because it can radiographically mimic cancer, pneumonia, tuberculosis, and lung abscess. They are characteristically found in upper lobes, frequently as multiple lesions with repeating pattern. In published literature surgery was required only in few cases in order to confirm diagnosis and additionally exclude malignancy so we present two such cases. Case: First case is a 68-years old female patient with mild asthma who was diagnosed on a routinely chest X ray with nodular lesion in anterior bronchial segment of upper right lobe. Bronchoscopy revealed diffuse hyperemia with an abundant amount of stiff mucopurulent secretion but normal passage into segmental bronchi. Malignant cells weren’t found in cytological specimen of brushed anterior segment. Computerized tomography confirmed a nodular lesion located in the upper right lobe of the lung 3x2 cm in diameter. Mini-thoracotomy was performed andmucoid impaction was confirmed. Afterwards she had three exacerbations and multiple infiltrates in upper rightlobe of the lung radiologically characteristic for mucoid impaction. This time infiltrates resolved spontaneously.Second case is a 57 years old female patient who presented with frequent cough, expectoration of hard plugs andlater on with a lesion in apical segmental bronchi of the left upper lobe. The patient underwent thoracotomy andthe patohistological diagnosis confirmed mucoid impaction. She also had during follow up period exacerbationsfollowed by a new opacity in the lower left lobe of the lungs. A chest CT was obtained, which demonstratedbranching opacities in the apical segment of left lower lobe which resemble to bronchocela. Conclusion: Mucoid impaction should be considered in diferential diagnosis of every patient with asthma and abnormal chest radiogram to avoid surgery. Imaging methods and bronchoscopy should be repeatedly performed before invasive methods. Mucoid impactions are frequently present in asthmatic patients and have tendency of repeating. Surgery is fortunately only in rare cases the sole excluding method of malignancy in asthmatic patients.

asthma; thoracic surgery; mucoid impaction

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