INTRODUCTION: Endobronchial foreign bodies usually present with cough and complications of obstruction such as atelectasis or pneumonia. We present a case of hemoptysis for two years caused by a foreign body.
CASE PRESENTATION: A 66-year-old white male presented to his primary care physician with a chief complaint of hemoptysis. Over a two-year period, the hemoptysis was scant and intermittent. He was a non-smoker with a history of only hypertension treated with amlodipine 5 mg daily and gastroesophageal reflux treated with lansoprazole 30 mg daily. CT scans of the chest and paranasal sinuses were normal, as were spirometry, lung volumes and carbon monoxide diffusing capacity. Laboratory studies showed no abnormalities. The patient was treated with several courses of antibiotics with no improvement, and a laryngologic examination was negative. A flexible bronchoscopy revealed an obstruction that occluded about 50% of the lumen of the bronchus intermedius. There was mild edema of the area, and the proximal portion of the occlusion showed polypoid granulation tissue emanating from the medial aspect of the bronchus with a yellowish mucous-like concretion. Distal to it was a lobulated mass protruding from the lateral aspect of the airway. A biopsy of the abnormality revealed inflammation, granulation tissue and plant matter with bacteria. Bronchoalveolar lavage was negative. A subsequent rigid bronchoscopy with laser exfulguration was performed, and a protruding foreign body was revealed which was extracted with difficulty. Pathology identified it as a pistachio nut shell. The distal bronchus was patent with mild edema of the distal segments. Patient tolerated the procedure well, and had no more hemoptysis. He had no recollection of aspiration events at any time.
DISCUSSIONS: Most endobronchial foreign bodies occur in children, and present with cough and obstructive sequelae such as atelectasis or pneumonia. Hemoptysis is uncommon, and distinctly rare without these sequelae. In this case, the patient had only hemoptysis for two years, and repeat CT scans of the chest did not reveal the foreign body. Also, it illustrates that patients with this disorder need not present with the classic risk factors for aspiration, nor recall that the event happened.
CONCLUSION: Patients with unexplained hemoptysis should be evaluated with bronchoscopy.
DISCLOSURE: Kelvin Shiu, None.