INTRODUCTION: Foreign body aspiration is more common in children than adults. In children, clinical symptoms and radiological findings have low diagnostic value. If not diagnosed or treated in a timely manner, delayed diagnosis (>4 weeks) increases the incidence of complications, one of which is bronchiectasis.
CASE PRESENTATION: A 27-year-old man was seen in clinic to evaluate a persistent cough that started four years prior, after he was diagnosed with pneumonia. He noted episodes of productive sputum, hemoptysis and shortness of breath several times per month. He denied fever, chills, or generalized malaise. On extensive questioning, he remembered inhaling or swallowing a fake tooth that was part of his vampire costume 8 years ago. He was evaluated in the ER at that time with no diagnostic testing or follow-up. Past medical history was unremarkable. Patient did not take any medications. He had no history of tobacco, alcohol, or illicit drug use. He denied occupational, chemical, dust, asbestos, or exotic pet exposure. He had no significant travel history. In clinic, the patient was in no respiratory distress, afebrile with normal vital signs. His SpO2 was 97% on room air. His chest exam and spirometry were normal. PA and lateral chest x-ray showed consolidation in the posterior segment of the right lower lobe. Chest CT showed right lower lobe volume loss with variable bronchiectasis and hyperlucent material in a basilar segment. Flexible bronchoscopy revealed granulation tissue occluding the right lower lobe bronchus. No foreign body was visualized. Rigid bronchoscopy, performed that day, revealed the edge of a foreign body that was removed with a forceps. The foreign body was a “V-shaped” plastic tooth approximately 1.5 cm at its base. Following extraction of the foreign body, a moderate amount of non-obstructing granulation tissue was present in the lower lobe bronchus. The basilar segmental airway appeared relatively normal. Patient will be seen at one month for repeat bronchoscopy to assess healing of the airway. Further studies, eg repeat chest CT for evaluation of bronchiectasis, may be indicated pending his clinical course.
DISCUSSIONS: Foreign body aspiration is more common in children than adults. Delayed diagnosis (>4 weeks) significantly increases the incidence of complications, mainly pneumonia, broncho-esophageal fistula, and bronchiectasis[3,4,5,6] and is attributed to misdiagnosis or negligence. In particular, bronchiectasis can develop 14 to 58 days after FB aspiration in animals. Even though bronchiectasis in general is considered permanent and irreversible, cylindrical bronchiectasis can be considered reversible. Though considered permanent and irreversible, case reports have showed that when the FB is removed, objective signs of bronchiectasis resolve.[5,9] More specifically, inorganic FB aspiration, once object is removed has shown no long-term affects..
CONCLUSION: The immediate diagnosis of foreign body aspiration is important to decrease long-term complications.
DISCLOSURE: Antonio Salud II, None.