Procedures: Student/Resident Case Report Poster - Procedures |

A Caustic Case of Acute Calcium Tablet Aspiration FREE TO VIEW

Jacqueline Hirsh, MD; Nicole Bournival, MD; Margaret Pisani, MD; Jonathan Puchalski, MD
Author and Funding Information

Yale-New Haven Hospital, New Haven, CT

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1027A. doi:10.1016/j.chest.2016.08.1133
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Procedures

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Foreign body aspiration usually occurs in those with neurologic impairment, advanced age, or intoxication and presents with a variety of symptoms (1). Bronchoscopy is used to retrieve the foreign body and, in severe cases, provide therapeutic intervention. Here we describe a case of calcium tablet aspiration resulting in subacute granulation tissue formation requiring bronchoscopic therapy.

CASE PRESENTATION: A 46-year-old woman with Behcet’s disease complicated by recurrent thrombotic events presented with left-sided pleuritic chest pain, cough, and dyspnea after aspirating a calcium citrate tablet that morning. On exam, she had normal oxygen saturation and non-labored breathing, but diminished left-sided breath sounds. Chest radiograph revealed a 1.8 cm oval density in the left mainstem bronchus with associated atelectasis. She underwent urgent bronchoscopy revealing inflamed mucosa of the proximal left mainstem bronchus and minute remnants of the calcium tablet. Endobronchial biopsies were obtained to confirm benign inflammation. The patient was discharged home the following day. She re-presented six days later with hemoptysis. Vital signs and exam were unremarkable. Chest CT with contrast was significant for a left mainstem bronchus soft tissue density, but no broncho-arterial fistulae. Repeat bronchoscopy revealed extensive granulation tissue with blood adherent to the medial wall of the proximal left mainstem bronchus. The airway was nearly completely obstructed, thus requiring debridement. Argon plasma coagulation was applied to the severely inflamed mucosa to prevent further granulation tissue formation and hemoptysis. Given the rapid recurrence, she was empirically started on fluticasone. She was seen in clinic three weeks later and had returned to her clinical baseline.

DISCUSSION: Aspiration of iron, potassium, metformin and pomegranate have been linked to airway injury requiring therapy ranging from dilation, mitomycin application or heat therapy to surgical resection (1). Although this patient presented acutely after aspiration of a calcium tablet and underwent an initial bronchoscopic survey demonstrating no endobronchial obstruction, she subacutely developed airway obstruction requiring intervention with forceps debridement and argon plasma coagulation. There are few prior reports of calcium tablet aspiration, none of which required intervention beyond removal. This case highlights the severe sequelae of pill aspiration and potential need for advanced bronchoscopic treatment.

CONCLUSIONS: Urgent bronchoscopy is important after pill aspiration (1). In this case, calcium citrate was significantly and rapidly caustic to endobronchial tissue, ultimately requiring bronchoscopic therapy.

Reference #1: Kinsey CM et al. Evaluation and management of pill aspiration: case discussion and review of the literature. Chest 2013; 143:1791-5.

Reference #2: Micallef J et al. Two cases of aspiration of calcium tablets. Lung India 2011; 28:312-314.

DISCLOSURE: The following authors have nothing to disclose: Jacqueline Hirsh, Nicole Bournival, Margaret Pisani, Jonathan Puchalski

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543