SESSION TITLE: Bronchology/Interventional Procedures Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Foreign body aspiration, a common cause of death in children, is relatively uncommon in adults (1). The preferred treatment for nonasphyxiating tracheobronchial foreign bodies is removal by rigid bronchoscopy (RB). Here, we report a case of an aspirated metallic dental appliance, a “grill”, and its removal by flexible bronchoscopy (FB).
CASE PRESENTATION: A 40 year old male with a history of alcohol abuse and chronic pancreatitis, presented to our emergency department with epigastric pain radiating to his chest. The patient reported feeling very tired the night prior to admission and upon awakening, could not find his “fronts”. His physical exam was notable only for mild hypertension. His heart and lungs were normal. A chest roentogram showed a radiodense object in the left mainstem bronchus (Figure 1). The patient was taken urgently to the endoscopy suite. FB via a laryngeal mask airway was performed and confirmed obstruction of the left main bronchus by a metallic body. Utilizing tripod forceps, the object was successfully extracted. Airway inspection revealed moderate amounts of secretions and granulation tissue in the left bronchial tree. The patient was admitted overnight for observation and discharged the following day.
DISCUSSION: Although there have been previous reports of aspirated dental appliances (1), to our knowledge, this is the first reported case of an aspirated “grill". The most common aspirated objects are food particles and teeth, but dental appliances are relatively rare. Although this patient was high risk for aspiration secondary to his decreased mental status from fatigue and possible alcohol use, this case is unique in many ways. First, the object was aspirated into the left main stem, instead of the more common right main stem. Second, the object was radiopaque, whereas the vast majority of foreign bodies are radiolucent. Finally, while RB is the common treatment for foreign body retrieval, we used FB for safe removal. FB which has been used for foreign body removal since the 1970s, is less invasive than rigid bronchoscopy.
CONCLUSIONS: Foreign Body aspiration occurs in adults and prompt recognition is crucial so there is no delay in management. Although RB is the preferred treatment, with proper training, FB remains a safe and viable option, especially when RB is not readily available.
Reference #1: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115(5);1357-1362
DISCLOSURE: The following authors have nothing to disclose: Ricardo Ortiz, Margaret Hayes, Sixto Arias, Lonny Yarmus, David Feller-Kopman, Hans Lee
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