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Sedhai Y, Bhat P, Spalitto D, Singh K, Waheed I, Khan T, Ahmed M, Kazimuddin N, Steff R. Iron pill aspiration syndrome: A case report and literature review. Respir Med Case Rep 2023; 45:101908. [PMID: 37609001 PMCID: PMC10440560 DOI: 10.1016/j.rmcr.2023.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
Aspiration of iron pill containing ferrous sulfate into the airway can induce fulminant chemical burn and necrosis of the airway mucosa. Acute chemical burn and inflammatory response can result in life-threatening airway compromise. It can also result in long-term sequelae including but not limited to fibrosis and airway stenosis. Considering the common use of iron supplements, and the potential severity of aspiration related airway injury, clinicians should be fully cognizant of the interaction between aspirated iron and airway passages. Herein, we present a case report with pertinent review of the literature.
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Affiliation(s)
- Y.R. Sedhai
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - P. Bhat
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - D. Spalitto
- Division of Internal Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - K. Singh
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - I. Waheed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - T.M.A. Khan
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - M.A. Ahmed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - N. Kazimuddin
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - R.T. Steff
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
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Ahmed H, Ahmed A, Hadique S. Melatonin aspiration: Treatment with flexible bronchoscopy. Respir Med Case Rep 2023; 45:101881. [PMID: 37334031 PMCID: PMC10275709 DOI: 10.1016/j.rmcr.2023.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
A 68-year-old male with past medical history 84 pack year smoking history (quit in 2000), mild chronic obstructive pulmonary disease (COPD), adenocarcinoma of right upper lobe treated with surgery and chemoradiation, and melanoma resection in 2013 presented with a one-month history of cough with sputum production and progressive dyspnea on exertion. He did not improve with standard treatment of antibiotics and steroids. He underwent flexible bronchoscopy that revealed an aspirated pill. This was successfully removed in the same session with the flexible bronchoscope.
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Bowden ET, Smith P, Dwyer KM. Pill aspiration: an under-recognised clinical entity. Med J Aust 2021; 215:505-506. [PMID: 34763364 DOI: 10.5694/mja2.51337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022]
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Kurnutala LN, Strother AW, Hierlmeier BJ. Incidental finding of tracheobronchial foreign body during double lumen tube placement-lessons learned. Saudi J Anaesth 2020; 14:514-516. [PMID: 33447196 PMCID: PMC7796750 DOI: 10.4103/sja.sja_237_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
Tracheobronchial foreign bodies are common in pediatric patients, but also seen in adult patients. Most of these patients present with history of foreign body inhalation, or with the symptoms like cough, respiratory distress. In this paper, we would like to report an incidental finding of a tablet in tracheobronchial tree during double lumen tube placement with fiberoptic bronchoscopy in a middle-aged patient scheduled for right lung decortication for hemothorax. We also learned that delay in removing the tablet would make the removal of foreign body complicated. The patient did not report any history of aspiration or have any signs and symptoms consistent with aspiration. We also discussed the difficult in diagnosing foreign-body aspiration in adults with nonspecific symptoms.
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Affiliation(s)
- Lakshmi N. Kurnutala
- Department of Anesthesiology, University of Mississippi Medical Center, Mississippi, USA
| | - Angela W. Strother
- Department of Anesthesiology, University of Mississippi Medical Center, Mississippi, USA
| | - Bryan J. Hierlmeier
- Department of Anesthesiology, University of Mississippi Medical Center, Mississippi, USA
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5
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Stoller JK. Giants in Chest Medicine: Professor Atul C. Mehta, MBBS, FCCP. Chest 2019; 155:254-257. [DOI: 10.1016/j.chest.2018.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022] Open
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Chu A, Krishna A, Paul MP, Sexton JF, Mirchia K. Obliterating Bronchiolitis: Result of Iron Pill Aspiration. Cureus 2018; 10:e2571. [PMID: 29974026 PMCID: PMC6029738 DOI: 10.7759/cureus.2571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Foreign body aspiration occurs in all age groups, especially in children and the elderly. The aspiration of an organic foreign body such as iron sulfate can cause significant bronchial destruction via oxidizing necrosis. When iron comes into contact with bronchial mucosa, it gets oxidized from ferrous ions into a ferric form which is highly toxic to the mucosa causing severe inflammation, mucosal damage, and fibrosis. Physicians should be very prudent with prescribing iron sulfate or any other pills in individuals who are at high risk of aspiration. Diagnosis is based on the history of iron aspiration, intense airway inflammation or necrosis on bronchoscopic examination, and iron particles observed on pathology. Prompt diagnosis and management should take place to prevent further morbidities. We report a case of 61-year-old female who was admitted to the hospital with a four-week history of aspirating iron pill. Computed tomography (CT) of the thorax showed ground glass infiltrates in the right lower lobe. She underwent flexible bronchoscopy which showed distal right bronchus intermedius (RBI) necrosis and stenosis with near-complete obstruction of distal RBI. She underwent multiple advanced bronchoscopic interventions with minimal improvement of the obliterated bronchus.
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Affiliation(s)
- Andrew Chu
- Pulmonary and Critical Care Medicine, SUNY Upstate Medical University
| | | | - Manju P Paul
- Pulmonary and Critical Care Medicine, SUNY Upstate Medical University
| | - James F Sexton
- Pulmonary and Critical Care Medicine, SUNY Upstate Medical University
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Ribeiro Neto ML, Gildea TR, Mehta AC. Health of Your Airways. J Bronchology Interv Pulmonol 2018; 25:81-84. [DOI: 10.1097/lbr.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Airway Obstruction Caused by Iron Pill Aspiration: An Interventional Pulmonology Approach to Prevent Surgery. Heart Lung Circ 2017. [PMID: 29519693 DOI: 10.1016/j.hlc.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Iron Pill Aspiration (IPA) is a challenging medical condition that requires prompt management to prevent detrimental outcomes. One of the most serious complications of IPA is airway inflammation which commonly leads to severe obstruction. Airway complications may require surgical intervention including the resection of the affected lung. Prompt recognition and management of IPA can reduce the risk of airway complications and may prevent the need of a surgical intervention. Bronchoscopic management entails the use of flexible and rigid bronchoscopes along with balloon bronchoplasty, ablation of the inflammatory tissue causing obstruction and airway stenting. In this report, we describe a case of severe airway obstruction secondary to iron pill aspiration with favourable outcome following bronchoscopic multimodalities intervention including temporary airway stenting.
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Abstract
While patients have been known to aspirate pills, they virtually never persist long enough to lead to complications. A spectrum of events, however, may arise especially from iron pill aspiration. If not identified and removed early, cytotoxic damage from local free-radical generation may result in airway damage. We report a case of an aspirated iron pill, which did not disintegrate and presented with chronic cough. Imaging revealed a foreign body in the right bronchus, and bronchoscopic removal allowed resolution of an associated pneumonia, without any further symptoms on subsequent surveillance.
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"Noninterventional Pulmonology": Birth of a New Subspecialty With Emergence of Interventional Pulmonology. J Bronchology Interv Pulmonol 2017; 24:1-3. [PMID: 27984380 DOI: 10.1097/lbr.0000000000000340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brewer DC, Regala M, Hess J. Calcium Pill Aspiration: A Case Report. J Emerg Med 2017; 52:e201-e202. [PMID: 28139269 DOI: 10.1016/j.jemermed.2016.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- David Clark Brewer
- Department of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Mark Regala
- Department of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Jamie Hess
- Department of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Sultan TA, van As AB. Review of tracheobronchial foreign body aspiration in the South African paediatric age group. J Thorac Dis 2016; 8:3787-3796. [PMID: 28149578 DOI: 10.21037/jtd.2016.12.90] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.
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Affiliation(s)
- Tamer Ali Sultan
- Trauma Unit, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa;; Paediatric Surgery Unit, Department of General Surgery, Menoufia University, Shebeen El-Kom, Egypt
| | - Arjan Bastiaan van As
- Trauma Unit, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Abstract
Aspiration of a foreign body into the lower airways is a common occurrence and can cause significant morbidity and mortality in humans. Most foreign bodies of the tracheobronchial tree are inanimate. However, the medical literature includes reports of live foreign bodies in the airways. Fish, leeches, and roundworms are the most common live foreign bodies of the lower airways. Fishermen are more prone to experience a live fish aspiration, whereas substandard conditions may expose individuals to leech and roundworm infestations. The dangers of and the approaches to the management of these foreign bodies differ from those associated with aspirated inanimate objects. The focus of this review of the medical literature was on live foreign body aspiration and its management.
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Affiliation(s)
- Syed Rizwan Ali
- Department of Critical Care Medicine, Bombay Hospital, Indore, India
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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Lee HY, Choi SM. Foreign Body Aspiration of a Press-Through Package That Lodged between the Vocal Cords. Am J Respir Crit Care Med 2016; 192:1517. [PMID: 26284505 DOI: 10.1164/rccm.201502-0350im] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ha Youn Lee
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; and.,2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; and.,2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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An Unusual Spectacle of Hemoptysis in Leukocytoclastic Vasculitis. J Bronchology Interv Pulmonol 2015; 23:54-8. [PMID: 26705013 DOI: 10.1097/lbr.0000000000000244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hsu AAL. Endoscopic intervention of lower airway foreign matter in adults-a different perspective. J Thorac Dis 2015; 7:1870-7. [PMID: 26623114 DOI: 10.3978/j.issn.2072-1439.2015.10.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lower airway foreign matter (FM) is uncommonly encountered in adults. This study reviews FM in the lower airway that required bronchoscopic intervention. METHODS A retrospective review of patients with FM in the lower airway seen at a tertiary hospital between 1996 and 2014 was undertaken. RESULTS Lower airway FM was removed in 80 out of 18,650 bronchoscopies performed. Forty-seven were males, with mean age of 50.8 (range, 29-78) years and mean symptom duration of 10.3 months (range, 1 day -20 years). The most common symptoms were persistent cough, followed by dyspnea, hemoptysis, episodes of choking and fever. Three-quarters of the patients had risk factors of either aspiration or iatrogenic cause for FM in the airway. FM identified following bronchoscopy was classified as: organic (31.3%), inorganic (46.3%) and endogenous matter (22.4%). Iatrogenic etiology was evident in four-fifths of the patients with inorganic FM (stents being the most common). Forty-eight (60.0%) patients had FM removed via flexible bronchoscopy, and the remainder via rigid bronchoscopy. The majority (27 out of 32) of FM removed by rigid bronchoscopy could not be removed using the flexible scope. This was primarily due to retrieval of stents [24] could only be done with the rigid bronchoscope. There were four FM-related complications (three bronchostenosis, one actinomycosis). CONCLUSIONS There is an increasing indication for bronchoscopists to retrieve FM, particularly of iatrogenic and endogenous sources, lodging in the lower airway of adults. There may be a reversing trend in the utilization of rigid bronchoscopy, mainly due to the increasing need to remove airway stents as more are deployed.
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Affiliation(s)
- Anne Ann Ling Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Küpeli E, Khemasuwan D. Response. Chest 2015; 147:e235. [PMID: 26033145 DOI: 10.1378/chest.15-0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Elif Küpeli
- Pulmonary Diseases Department, Baskent University School of Medicine Ankara, Turkey.
| | - Danai Khemasuwan
- Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic. Cleveland, OH
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Hochhegger B, Irion KL, Zanetti G, Marchiori E. A Curious Case of Pill Aspiration. Chest 2015; 147:e234-e235. [DOI: 10.1378/chest.15-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.
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Affiliation(s)
- Xiaowen Hu
- Department of Respiratory Disease, Anhui Provincial Hospital, Hefei, China
| | - Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA
| | - Paolo T Pianosi
- Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Foreign Body Aspiration in the Elderly Patient. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. "Pills" and the air passages: a continuum. Chest 2015; 147:242-250. [PMID: 25560862 DOI: 10.1378/chest.14-0531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recently, we reported a number of key, common medications that affect the air passages in a variety of fashions. The purpose of this article is to provide a comprehensive review of the literature on the subject, including supportive articles published in languages other than English. The presented information was gathered by a review of the English literature, by cross referencing, and by communication with other interventional pulmonologists. We identified several additional medications causing either direct or systemic effects on the air passages. In this review, we update the clinical presentation, mechanism of injury, diagnosis, and management of the airway complications related to these medications.
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Affiliation(s)
- Elif Kupeli
- Pulmonary Diseases Department, Baskent University School of Medicine, Ankara, Turkey
| | - Danai Khemasuwan
- Pulmonary and Critical Care Medicine Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Atul C Mehta
- Lerner College of Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH..
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Refractory Hypoxemia Due to Sodium Polystyrene Sulfonate (Kayexalate) Aspiration. Ann Am Thorac Soc 2014; 11:993-5. [DOI: 10.1513/annalsats.201403-114le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Mehta AC, Khemasuwan D. A foreign body of a different kind: Pill aspiration. Ann Thorac Med 2014; 9:1-2. [PMID: 24551009 PMCID: PMC3912679 DOI: 10.4103/1817-1737.124404] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 12/05/2022] Open
Affiliation(s)
- Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
A presence of black pigmentation involving the endobronchial tree is not uncommon. It was first described in the literature in association with occupational exposure in the early 1940s. However, in 2003, Packham and Yeow formally used the term black bronchoscopy to describe endobronchial metastasis from a malignant melanoma. Hyperpigmentation of the airway, however, is associated with multiple etiologies such as congenital disease, inborn errors of metabolism, infections, environmental exposures, neoplasm, and iatrogenic causes. Although the majority of these conditions are benign, a proper diagnosis is important for optimal management. In this article, we review the etiology of black bronchoscopy and discuss its presentations and current management guidelines.
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Affiliation(s)
| | - Tanmay S Panchabhai
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Danai Khemasuwan
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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