SESSION TYPE: Miscellaneous Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Foreign body aspiration is an uncommon problem in adults with 80 percent of cases occurring in children under age 15. Foreign body aspiration can be a life threatening condition with 500-2000 deaths each year in the United States. We report a case of a 48-year old male who aspirated his dental prosthesis during sleep and underwent successful retrieval using flexible bronchoscopy
CASE PRESENTATION: A 48-year old Hispanic male with a history of asthma and aortic regurgitation status post aortic valve replacement presented due to acute onset of dyspnea. The patient awoke feeling short of breath with a new cough, productive of white sputum and a general feeling of respiratory discomfort. He did not have pain or hemoptysis. He noticed that his dental bridge was missing and went to the emergency department. Upon arrival, he was saturating 95 percent on room air. Physical exam was significant for decreased air entry on the left side. Chest x-ray revealed lodging of the dental prosthesis in the left main stem bronchus. The patient was admitted to the intensive care unit and underwent bronchoscopy which showed the dental bridge in the left main-stem bronchus. Endobronchial forceps were used to grasp the wire frame of the dental prosthesis which was successfully retrieved. The patient was observed for four hours during which he reported dramatic improvement of dyspnea. He was discharged in a stable condition
DISCUSSION: Airway foreign bodies are an uncommon occurrence but can cause significant morbidity and mortality. The success rate of fiberoptic bronchoscopic extraction in adults ranges from 60 to 90 percent . Foreign bodies most often lodge in the right main stem bronchus due to airway anatomy; however they have been documented in all airway locations. Bronchoscopic extraction of a foreign body, even by a skilled operator, is a complex procedure and must be done in a monitored setting with resuscitative measures available. Corticosteroids are not recommended as a prophylactic measure for post operative subglottic edema however they can be used in cases of established subglottic edema. Antibiotics are not indicated except in the setting of documented respiratory tract infection.
CONCLUSIONS: Immediate removal of tracheobronchial foreign body is essential to prevent life threatening complications. Procedure outcome varies significantly dependent on the type and location of the obstructing foreign body as well as the level of experience of the bronchoscopist.
1) Limper Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990;112:604.
DISCLOSURE: The following authors have nothing to disclose: Monay Mahmoud, Syed Imam, Matthew King
No Product/Research Disclosure InformationMeharry Medical College, Nashville, TN