SESSION TYPE: Airway Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Foreign body aspirations, although more common amongst children and the elderly, can lead to severe infections.
CASE PRESENTATION: A 33 year old male with no known past medical history presented with a 3 month history of fatigue, episodic fevers, and cough with productive sputum. Patient was seen in a walk in clinic at the onset of symptoms and was told that he had a bronchitis and he was prescribed a 5 day course of azithromycin which did not resolve his symptoms. He denied any weight loss or other constitutional symptoms. Also he denied having any recent sick contacts. Furthermore he had a recent HIV test which was negative. On admission, the patient was febrile to 39.2°C, BP 90/56, HR 120, RR 26, 91% on 2L NC. Exam was significant for tachycardia, decreased breath sounds on the right lung base as compared to the left, and diaphoresis. Labs was significant for a wbc count of 39 K/mcL. Otherwise unrevealing. An XR of the chest revealed foreign body aspiration in the right intermediate bronchus with superimposed pneumonia. Upon further questioning, it was illicited that the patient was involved in an altercation where he presumably lost his imitation gold teeth cover. The patient was started on broad spectrum Vancomycin and Zosyn. He continued to remain hypotensive and febrile despite broad antibiotic coverage. Interventional pulmonology was consulted. A bronchoscopy was performed with retrieval of the foreign object. The retrieval of the object was complicated by formation of granulation teeth; however it was finally able to be retrieved. Given the extent of granulation tissue, the patient underwent a significant amount of laser ablation of lung tissue. Over the next few days, the patient deferversed and improved clinically.
DISCUSSION: Foreign body in the bronchus can present with variable symptoms depending on the severity. These can range from nonspecific respiratory complaints to long-term irreversible damage. Prompt recognition of the aspiration of the foreign body is important to identify as inflammatory granulation can develop as occurred with our patient.
CONCLUSIONS: Foreign body aspiration can lead to severe infections. Prompt recognition is essential to prevent the sequelae of inflammatory granulation.
1) Takenaka, M, et al. Management of patients with bronchial foreign bodies. Journal of UOEH 2011; 33(2),157-61.
DISCLOSURE: The following authors have nothing to disclose: Aalok Patel, Edwin Nunnery, Bhavin Adhyaru
No Product/Research Disclosure InformationEmory University School of Medicine, Atlanta, GA