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A Curious Case of Pill AspirationPill Aspiration FREE TO VIEW

Bruno Hochhegger, MD, PhD; Klaus Loureiro Irion, MD, PhD; Gláucia Zanetti, MD, PhD; Edson Marchiori, MD, PhD
Author and Funding Information

From the Department of Radiology (Dr Hochhegger), Santa Casa de Porto Alegre, Porto Alegre; the Department of Radiology (Dr Irion), Liverpool Heart and Chest Hospital and the Royal Liverpool University Hospital NHS Trusts; and the Department of Radiology (Drs Zanetti and Marchiori), Federal University of Rio de Janeiro.

CORRESPONDENCE TO: Edson Marchiori, MD, PhD, Rua Thomaz Cameron, 438, Valparaiso, CEP 25685, 120, Petrópolis, Rio de Janeiro, Brazil; e-mail: edmarchiori@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):e234-e235. doi:10.1378/chest.15-0184
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To the Editor:

We read with great interest in a recent issue of CHEST (January 2015) the well-written article by Küpeli et al,1 who reviewed the literature regarding the effects of common medications (particularly pills) on the air passages. They stated that pills can affect the airways via local inflammatory, obstructive, or systemic effects. They noted that radiopaque pills can be visualized on plain chest radiographs and chest CT scans without contrast, whereas radiolucent pills are visualized only by bronchoscopy or are detected via the indirect effect of airway obstruction.1

We report the curious case of a patient who aspirated a pill with its plastic packaging. A 53-year-old man presented with a 3-month history of cough, but no history of asthma or smoking. Physical examination and laboratory findings were normal. A chest radiograph was interpreted as normal, and he was treated with an inhaled bronchodilator; this treatment resulted in some improvement, and the patient was discharged. The cough persisted, and 4 weeks later he returned with intermittent minor hemoptysis. Chest CT scan demonstrated the presence of a pill and blister pack in the right intermediary bronchus (Fig 1). The patient was then questioned specifically regarding any history of aspiration, and he remembered an incident 6 months previously in which he swallowed a pill to treat a headache before going to sleep. He reported being very drunk at the time and recalled having coughed after taking the pill. Flexible bronchoscopy under general anesthesia revealed a foreign body in the right intermediary bronchus, and the pill with the blister pack was removed by rigid bronchoscopy.

Figure Jump LinkFigure 1 –  CT images showing a radiopaque blister pack in the right intermediary bronchus (arrows). A, Axial. B, Coronal. C, Sagittal. D, Coronal magnification showing the borders of the blister pack (arrowheads).Grahic Jump Location

Foreign body aspiration (FBA) is the most common cause of intraluminal airway abnormalities in children but is unusual in adults and is often overlooked as a cause of airway obstruction. Diagnosis can be difficult because patients may not recall the episode of aspiration.2-4 A detailed history and high index of suspicion are necessary to arrive at the correct diagnosis.3 Although some patients are asymptomatic, complications of pill aspiration include airway obstruction, atelectasis, granulation tissue formation, bronchial stenosis, postobstructive pneumonia, hemoptysis, and bronchiectasis.2,3 Plastic- or enteric-coated capsules are more “inert,” causing fewer complications.2

All cases of FBA should be treated as medical emergencies.1,2 Bronchoscopy remains the ideal instrument for diagnosis and retrieval of foreign bodies. Neglected cases of FBA may require surgical intervention.3 In conclusion, physicians must remember to include FBA in the differential diagnosis of chronic cough.

References

Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “Pills” and the air passages: a continuum. Chest. 2015;147(1):242-250. [PubMed]
 
Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest. 2013;144(2):651-660. [PubMed]
 
Micallef J, Montefort S, Mallia Azzopardi C, Galea J. Two cases of aspiration of calcium tablets. Lung India. 2011;28(4):312-314. [CrossRef] [PubMed]
 
Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 2000;20(3):673-685. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  CT images showing a radiopaque blister pack in the right intermediary bronchus (arrows). A, Axial. B, Coronal. C, Sagittal. D, Coronal magnification showing the borders of the blister pack (arrowheads).Grahic Jump Location

Tables

References

Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “Pills” and the air passages: a continuum. Chest. 2015;147(1):242-250. [PubMed]
 
Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest. 2013;144(2):651-660. [PubMed]
 
Micallef J, Montefort S, Mallia Azzopardi C, Galea J. Two cases of aspiration of calcium tablets. Lung India. 2011;28(4):312-314. [CrossRef] [PubMed]
 
Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 2000;20(3):673-685. [CrossRef] [PubMed]
 
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