clinical investigations Endobronchial Suture* A Foreign Body Causing Chronic Cough Deborah Shure, M.D., F.C.C.P.

Although rarely considered in series of lower airway foreign bodies, endobronchial sutures can cause chronic cough or hemoptysis years after thoracic surgery. Eight endobronchial sutures were found in six patients who had undergone surgery four to 30 years prior to admission. Symptoms began two to 25 years after surgery and lasted from two to six years prior to diagnosis. Cough had been attributed to chronic bronchitis or bronchiectasis in five patients and to tracheal narrowing secondary to surgical repair of tracheomalacia in the sixth. Bronchoscopy was diagnostic in all

cases. Suture removal was performed with either forceps or endoscopic suture scissors to cut the suture followed by extraction with forceps. Symptoms resolved within three days and granulation tissue by two to four weeks after suture removal. This series suggests that endobronchial suture should be considered in patients with a history (even remote) of previous thoracic surgery who present with chronic, persistent cough unresponsive to specific therapy for any underlying pulmonary disease. (Chest 1991; 100:1193-(6)

Chronic cough can present a difficult diagnostic dilemma. The most common causes, such as chronic bronchitis, asthma, bronchiectasis, postnasal drip, and gastroesophageal reflux, can usually be suspected on the basis of the history and physical examination and confirmed by diagnostic tests and responses to specific therapy. I The presence of a foreign body in the lower airways is less often considered as a cause of chronic cough in adults.1,2 When foreign bodies are considered, recognition is usually limited to aspirated foreign bodies. Endobronchial sutures constitute nonaspirated foreign bodies that have not been considered in large series. 3 •4 Endobronchial sutures can, however, cause cough months to years after thoracic surgery.5.6 This report describes six cases of cough secondary to endobronchial sutures, with onset of symptoms two to 25 years after surgery, and a simple method for suture removal through the fiberoptic bronchoscope.

m~) and intravenous meperidine (75 to 150 mW. Topical anesthesia was initiated with ultrasonically nebulized tetracaine. Additional tetracaine was administered throuW! the bnmchoscope channel as needed. Bronchosmpy was performed transnasally with a largechannel (2.6-mm-diameter) /iberoptic bronchoscope (Olympus, Lake Success, NY) and the patient in the supine position. Oxygen was administered during the pnx.'edure. Sutures were removed with either standard cup forceps or alligator forceps. In some cases, the suture was /irst cut with endoscopic suture scissors (Olympus, Lake Su

Endobronchial suture. A foreign body causing chronic cough.

Although rarely considered in series of lower airway foreign bodies, endobronchial sutures can cause chronic cough or hemoptysis years after thoracic ...
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