Case Study
Unusual bronchial foreign body Paresh Kumar Kuba, Jasvinder Sharma and Ashok Kumar Sharma
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(9) 1132–1134 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315592995 aan.sagepub.com
Abstract We present an unusual case of bronchial foreign body in an adult who presented with bronchiectasis more than two decades later. The patient was unaware of his accidental aspiration of the foreign body, and the final diagnosis was made intraoperatively.
Keywords Bronchiectasis, Bronchoscopy, Foreign bodies, Pneumonectomy, Lung, Respiratory aspiration
Case report A 41-year-old gentleman presented with suicidal tendencies because of repeated respiratory tract infections with large amounts of foul smelling expectoration for the previous two years. He denied any history of foreign body aspiration. Investigations revealed severe bronchiectasis of the right lower and middle lobes (Figure 1). Bronchoscopy showed narrowing of the intermediate bronchus with no evidence of a foreign body. A bronchial biopsy was performed through bronchoscopy, but it was inconclusive. A right middle and lower lobectomy was difficult because of a very thick intermediate bronchus. On sectioning the specimen, a beer-can pull top (or ring pull) was found obstructing the intermediate bronchus, with severe distal bronchiectatic changes (Figure 2). The patient was discharged on the 5th postoperative day. On further interrogation, he admitted having a severe bout of coughing after a few beers in a bar at the age of 18 years. He possibly aspirated the pull-top then, which remained undetected for over two decades. A retrospective review of the computed tomography showed the foreign body that was missed earlier (Figure 3). Fourteen years later, the patient was doing well and was asymptomatic.
Discussion Foreign body aspiration in adults is usually seen in the very elderly or in patients with underlying neurological conditions, psychiatric illnesses, Alzheimer disease, or
head trauma.1 The common symptoms include vigorous coughing with or without hemoptysis, dyspnea, wheezing, and recurrent pneumonia. However, the diagnosis is sometimes delayed because of the nonspecific presentation. The reported mean duration of foreign body retention ranges from 18.4 to 25.8 months.2,3 In this patient, the foreign body was detected after more than two decades. Not all foreign bodies are visible on a chest radiograph. The most common findings are pulmonary infiltrations, atelectasis, hyperinflation, bronchiectasis, or even a completely normal radiograph.4,5 Most often, the foreign body gets lodged in the right intermediate or basal bronchi because of the right bronchus being more vertical and aided by gravity. The diagnosis is based on chest radiography, computed tomography, and bronchoscopy. Early diagnosis of an aspirated foreign body entails a high index of suspicion in adults when the symptoms and signs may be minimal and the history may not be forthcoming.
Wakefield Heart Centre & Capital and Coast District Health Board, Wellington, New Zealand Corresponding author: Ashok Kumar Sharma, Cardiothoracic Surgery Division, Department of Surgery, P.O. Box 35, Sultan Qaboos University Hospital, Muscat 123, Oman. Email: [email protected]
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
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Figure 1. Computed tomography of the chest showing bronchiectasis.
Figure 2. Section of the lung showing the beer can pull-top and extensive bronchiectatic changes.
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
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Asian Cardiovascular & Thoracic Annals 23(9)
Figure 3. Computed tomography showing the unsuspected foreign body.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
References 1. Mise K, Jurcev Savicevic A, Pavlov N and Jankovic S. Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995–2006. Surg Endovasc 2009; 23: 1360–1364.
2. Chen CH, Lai CL, Tsai TT, Lee YC and Perng RP. Foreign body aspiration into the lower airway in Chinese adults. Chest 1997; 112: 129–133. 3. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J 1994; 7: 510–514. 4. Baharloo F, Veyckemans F, Francis C, Biettlot MP and Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115: 1357–1362. 5. Ernst KD and Mahmud F. Reversible cystic dilation of distal airways due to foreign body. South Med J 1994; 87: 404–406.
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
Unusual bronchial foreign body Paresh Kumar Kuba, Jasvinder Sharma and Ashok Kumar Sharma
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(9) 1132–1134 ß The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492315592995 aan.sagepub.com
Abstract We present an unusual case of bronchial foreign body in an adult who presented with bronchiectasis more than two decades later. The patient was unaware of his accidental aspiration of the foreign body, and the final diagnosis was made intraoperatively.
Keywords Bronchiectasis, Bronchoscopy, Foreign bodies, Pneumonectomy, Lung, Respiratory aspiration
Case report A 41-year-old gentleman presented with suicidal tendencies because of repeated respiratory tract infections with large amounts of foul smelling expectoration for the previous two years. He denied any history of foreign body aspiration. Investigations revealed severe bronchiectasis of the right lower and middle lobes (Figure 1). Bronchoscopy showed narrowing of the intermediate bronchus with no evidence of a foreign body. A bronchial biopsy was performed through bronchoscopy, but it was inconclusive. A right middle and lower lobectomy was difficult because of a very thick intermediate bronchus. On sectioning the specimen, a beer-can pull top (or ring pull) was found obstructing the intermediate bronchus, with severe distal bronchiectatic changes (Figure 2). The patient was discharged on the 5th postoperative day. On further interrogation, he admitted having a severe bout of coughing after a few beers in a bar at the age of 18 years. He possibly aspirated the pull-top then, which remained undetected for over two decades. A retrospective review of the computed tomography showed the foreign body that was missed earlier (Figure 3). Fourteen years later, the patient was doing well and was asymptomatic.
Discussion Foreign body aspiration in adults is usually seen in the very elderly or in patients with underlying neurological conditions, psychiatric illnesses, Alzheimer disease, or
head trauma.1 The common symptoms include vigorous coughing with or without hemoptysis, dyspnea, wheezing, and recurrent pneumonia. However, the diagnosis is sometimes delayed because of the nonspecific presentation. The reported mean duration of foreign body retention ranges from 18.4 to 25.8 months.2,3 In this patient, the foreign body was detected after more than two decades. Not all foreign bodies are visible on a chest radiograph. The most common findings are pulmonary infiltrations, atelectasis, hyperinflation, bronchiectasis, or even a completely normal radiograph.4,5 Most often, the foreign body gets lodged in the right intermediate or basal bronchi because of the right bronchus being more vertical and aided by gravity. The diagnosis is based on chest radiography, computed tomography, and bronchoscopy. Early diagnosis of an aspirated foreign body entails a high index of suspicion in adults when the symptoms and signs may be minimal and the history may not be forthcoming.
Wakefield Heart Centre & Capital and Coast District Health Board, Wellington, New Zealand Corresponding author: Ashok Kumar Sharma, Cardiothoracic Surgery Division, Department of Surgery, P.O. Box 35, Sultan Qaboos University Hospital, Muscat 123, Oman. Email: [email protected]
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
Kuba et al.
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Figure 1. Computed tomography of the chest showing bronchiectasis.
Figure 2. Section of the lung showing the beer can pull-top and extensive bronchiectatic changes.
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
1134
Asian Cardiovascular & Thoracic Annals 23(9)
Figure 3. Computed tomography showing the unsuspected foreign body.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
References 1. Mise K, Jurcev Savicevic A, Pavlov N and Jankovic S. Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995–2006. Surg Endovasc 2009; 23: 1360–1364.
2. Chen CH, Lai CL, Tsai TT, Lee YC and Perng RP. Foreign body aspiration into the lower airway in Chinese adults. Chest 1997; 112: 129–133. 3. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J 1994; 7: 510–514. 4. Baharloo F, Veyckemans F, Francis C, Biettlot MP and Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115: 1357–1362. 5. Ernst KD and Mahmud F. Reversible cystic dilation of distal airways due to foreign body. South Med J 1994; 87: 404–406.
Downloaded from aan.sagepub.com at Duke University Libraries on November 17, 2015
