Acute airway obstruction by a mucus plug in a patient with a 12-year history of inserting a double cannula tracheostomy tube: A case report

Foreign Body Misdiagnosed as Mucus Plugging After Percutaneous Tracheostomy

We report a case of a 59-year-old male who presented with a persistent cough for a year after being discharged from critical care following a subarachnoid haemorrhage. As part of his initial critical care management and in order to allow full neurological assessment, the patient required a period of prolonged mechanical ventilation, which necessitated a percutaneous tracheostomy. Following recovery and subsequent discharge, the patient presented on multiple occasions with cough, undergoing serial computed tomography (CT) scans which reported mucus plugging as a possible cause of the cough. As his symptoms continued to worsen, a flexible bronchoscopy was carried out, which identified a foreign body in the trachea. This object was later recognised as a retained part of the guiding catheter, part of the percutaneous tracheostomy tube dilator. After the object was retrieved, the patient reported a complete resolution of symptoms. Percutaneous tracheostomy is a common procedure within critical care units, and early complications such as bleeding or airway obstruction are typically recognised immediately after insertion. This report documents a late complication caused by the retention of a foreign object from insertion, which was misdiagnosed on serial CT scans, leading to persistent cough over a period of months.