Welcome to the cough mystery solved – a surprising diagnosis of the case study presented by Dr. Lisa Sanders in the New York Times. Spoiler Alert: The surprising diagnosis is foreign body aspiration. Read on to follow the steps that led to this conclusion.
In Part 1, a 43-year old man had been suffering from an annoying and persistent cough for 18 months. During this time, he saw a primary care physician, ear-nose-and-throat specialist and pulmonologist for his cough. His doctors prescribed an antihistamine for allergies, an inhaler for asthma, and antacid medication for heartburn – but the cough did not go away. So, the man tried to learn to live with the persistent cough. Then, he began coughing-up blood.A CT scan of his chest in the Emergency Room showed a hole in his right lung – suggesting tuberculosis. But, the doctor thought tuberculosis was unlikely because the patient looked otherwise healthy. The patient was also tested for other infections. Finally, a scope was inserted down his throat and the doctor removed a black and smooth object. The doctor recognized the object as a seed and the patient confirmed that it was a sunflower seed.
Turns out, sunflower seeds are the man’s favorite snack. And he remembered being at a baseball game a year and a half earlier, cracking open a sunflower seed with his teeth, and one of the seeds “going down the wrong pipe.” He remembered his body trying to cough-it-up and expel the foreign object. Finally, the coughing stopped so he forgot about it – that is until a few weeks later when the coughing returned. The patient had reported the sunflower seed incident to the doctors he had seen over the last 18 months, but they thought it unlikely that something was lodged in his lungs. Typically, this kind of situation happens to young children rather than adults.
Did you guess the diagnosis correctly? The doctor confirmed a diagnosis of “foreign body aspiration.” The patient stopped coughing after the sunflower seed was removed.
You should not learn to live with an unexplained cough that just won’t go away. A persistent cough should not be ignored; it can be an indication of an underlying medical problem.
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