Successful Removal of a Chronic Aspirated Foreign Body after Twelve Years

A pea in a peculiar place: Unusual case of left upper lobe bronchial foreign body

Key Clinical Message

Foreign body aspiration is common in old age, sometimes lodged in unusual locations like the left upper lobe bronchus when aspiration happens in a recumbent position. Computed tomography is the preferred diagnostic tool, while flexible bronchoscopy is effective for removing the foreign body.

Abstract

Tracheo-bronchial foreign body aspiration (FBA) is common in children and elderly, but often goes unnoticed due to vague symptoms and atypical imaging findings. We present a case of aspiration of pea in elderly presenting with acute symptoms. Computed tomography (CT) reveled an atypical site of foreign body (FB), that is left upper lobe bronchus and immediate removal of the FB was done using a flexible bronchoscope. The symptoms subsided after removal of the FB. Missed FBs can lead to chronic issues like pneumonia and airway obstruction. Advanced age, psychiatric illness, stroke, seizure disorder, and neuromuscular disease increase the risk of aspiration in older adults. Commonly, FBs get lodged in the right middle and lower lobes after aspiration due to vertical orientation of the airways. CT is a helpful tool for diagnosis of FBA and flexible bronchoscopy is effective in removal of the FB in elderly.

CT Characteristics and Clinical Findings of Bronchopneumonia Caused by Pepper Aspiration

Purpose

To explore the computed tomography (CT) features of bronchopneumonia caused by pepper aspiration to improve the diagnosis.

Materials and Methods

28 adult patients diagnosed with obstructive pneumonia caused by pepper aspiration from January 2016 to September 2022 were enrolled. The CT characteristics of bronchial changes and pulmonary lesions caused by pepper were analyzed and summarized.

Results

Among 28 patients, the most common symptom was cough (26, 92.9%), followed by expectoration (23, 82.1%). Bronchoscopy revealed that peppers were mainly found in the bronchus of the right lower lobe (n = 18, 64.3%), followed by the bronchus of the left lower lobe (n = 5, 17.9%). In combination with bronchoscopy results, the pepper in the bronchus manifested as circular or V/U-shaped high-density, localized soft tissue, and flocculent opacification in 8 (28.6%), 16 (57.1%), and 3 (10.7%) cases on CT images, respectively. The bronchial wall around the pepper was thickened with localized occlusion (n = 19, 67.9%) and stenosis (n = 9, 32.1%). Regarding adjacent bronchi without peppers, extensive wall thickening with stenosis and/or occlusion was found in 23 (82.1%) cases. Distal pulmonary lesions frequently involved two or three segments (21, 75.0%) and mainly presented as patchy consolidation or atelectasis (24, 85.7%).

Conclusion

In combination to a history of eating peppers and clinical symptoms, bronchopneumonia caused by pepper should be highly suspected if U/V-shaped and annular high-density or localized soft tissue density is detected in the bronchi of the lower lobes, accompanied by extensive bronchial wall thickening, stenosis, or occlusion, and consolidation or atelectasis in multiple distal lung segments.

Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report

Although aspiration of a foreign body into the trachea and bronchi can occur in all age groups, it is more common in infants and young children. Foreign bodies in the tracheobronchial tree are uncommon in adults and mainly present in patients with dysphagia and an altered level of consciousness. The identification of foreign bodies in the tracheobronchial tree is frequently overlooked or delayed, leading patients to present later with chronic symptoms and potential complications. These complications may include persistent coughing, wheezing, obstructive pneumonitis, bronchiectasis, and abscess formation secondary to recurrent pulmonary infections. This article aims to present the case of a 27-year-old patient without risk factors for aspiration who has experienced recurrent self-limiting hemoptysis episodes for five years. Bronchoscopy revealed a foreign body at the entrance to the middle lobe bronchus. The presence of a foreign body in the tracheobronchial tree should be considered in any patient with recurrent hemoptysis. Bronchoscopy leads to accurate diagnosis, treatment, and prevention of complications.

A Trip Down the Bronchus- A Tracheostomy Complication in COVID Pandemic

Foreign body of the trachea and the bronchus are critical emergencies which can lead to life threatening complications. But the advent of the 2019 novel corona virus disease, pandemic has dramatically changed the comfort of these procedures since aerosol generating medical procedures pose a risk and spread of infection to the health care workers. Even the patients are uncomfortable visiting the hospital due to the fear of acquiring the COVID infection.A 41-year-old obese female with grade 4 subglottic stenosis status post tracheostomy presented with foreign body Fuller’s tracheostomy tube flange in the right bronchus during the COVID 19 pandemic. The patient had delayed presentation to the hospital due to fear of getting exposed to COVID and poor access to health care facilities due to lockdown imposed in various places in the nation. The patient was tested for COVID and taken up for surgery where rigid bronchoscopy and foreign body removal was done via the tracheostoma. The details of the procedure, challenges faced during the procedure, the effect of the COVID pandemic on the patients and hospital staffs are discussed. The complications of the broken tracheostomy tube can be most efficiently dispelled by proper tube care by the attenders and frequent tube change.

Asymptomatic fixed partial denture aspiration: A case report

Introduction and importance

Foreign body aspiration (FBA) is more frequently presented in children and considered a rare presentation in adults. One of the most common causes of FBA in adults are orthodontic appliances.

Case presentation

We present a case of a 70-year-old male with an accidently discovered fixed partial denture (bridge) in the right mainstem bronchus. The partial denture was removed successfully by flexible bronchoscopy.

Clinical discussion

FBA is an event that most frequently occurs with children, and rarely with adults having various risk factors and complications on patients.

Conclusion

This study aims to spotlight the danger of asymptomatic FBA and how retrieving sharp objects can be managed by flexible bronchoscopy thus leading to better management and increased awareness of such cases.

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Foreign Body Aspiration (FBA) is very uncommon in adults.

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Dental procedures and appliances are considered the second most common leading cause of FBA.

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High level of physicians' susception is needed to identify FBA cases in adults is needed.

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Flexible bronchoscopy has an important role in retrieving aspirated foreign bodies.

Chronic cough and uncontrolled asthma: Ending a three year clinical course with successful foreign body removal

Acute foreign body aspiration can cause severe damage to the respiratory system, leading to laceration and even death due to asphyxia. However, a foreign body that has been aspirated could go unnoticed acutely and lead to persistent shortness of breath symptoms. Most of the patients will be able to recall the acute aspiration event, but others do not. On the latter, a more meticulous approach will lead to the diagnosis and subsequent effective management. We hereby present the case of a 52-year-old male with history of partly controlled severe asthma and chronic persistent cough with bloody sputum. Upon evaluation, he was found with a right-sided pneumonia and pertinent history remarkable for several episodes of bronchitis in the past 3 years. There circumstances and subsequent images led to the successful finding and removal of a chronic foreign body aspirated 3 years prior to evaluation. A procedure led to almost complete resolution of symptoms of cough and asthma.