Procedures: Student/Resident Case Report Poster - Procedures |

Management of Iron Pill Aspiration Syndrome: Advanced Bronchoscopic Intervention FREE TO VIEW

Monali Patil, MD; Arjun Mohan, MD; Kassem Harris, MD
Author and Funding Information

University at Buffalo, Buffalo, NY

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

Chest. 2016;150(4_S):1041A. doi:10.1016/j.chest.2016.08.1147
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 is common and adults in their sixth or seventh decades of life are at a higher risk due to failure of their airway protective mechanism 1. We report a case of advanced broncoscopy procedure for the management of iron pill aspiration.

CASE PRESENTATION: A 70-year-old female patient presented to our interventional pulmonary clinic after three months of with progressively worsening dyspnea after accidental aspiration of an iron pill. She underwent a work up that included chest computerized, and flexible bronchoscopy that showed an ovoid lesion in of bronchus intermedius without evidence of airway stenosis. Her physical examination was notable for right sided inspiratory and expiratory wheezing. We performed a flexible and rigid bronchoscopy, which showed a near complete obstruction of the BI behind a pearly ovoid lesion (figure 1A-B). The stenotic lesion was inflammatory, fibrotic and circumferential. Endobronchial biopsies were performed and airway intervention was performed using fogarty and controlled radial expansion balloon dilation followed by rigid bronchoscopy dilation. Given the complex nature of the stenosis, a silicone stent was deployed in the BI. (figure 1C and 1D). The procedure was uneventful. Pathologic examination revealed subepithelial bronchial metaplasia, acute on chronic inflammation and subepithelial foreign body giant cell reaction. These findings were consistent with the diagnosis of iron pill aspiration induced bronchial stricture. The stent was in place for year with regular follow up. After one year the stent was removed, the bronchus intermedius was about 50% narrowed post stent removal and right middle lobe bronchus and right lower lobe bronchus were normal (figure 2). The patient remains asymptomatic and no resetting was needed 3 months post stent removal.

DISCUSSION: Iron pill aspiration (IPA) syndrome is the most commonly described pill aspiration event2. The spectrum of manifestation of IPA varies from acute mucosal damages to scarring and fibrosis 3. Bronchial stenosis is a late manifestation of IPA and can be life-threatening in patients with coexisting lung conditions. Evidence of critical complex stenosis, rapid disease progression and severe airway inflammation prompted us to deploy a bronchial stent. To the best of our knowledge, such an intervention for IPA syndrome has not been performed till date.

CONCLUSIONS: Patients with bronchial stenosis due to IPA can be successfully managed by advanced bronchoscopic interventions.

Reference #1: Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Annals of internal medicine. Apr 15 1990;112(8):604-609.

Reference #2: Kinsey CM, Folch E, Majid A, Channick CL. Evaluation and management of pill aspiration: case discussion and review of the literature. Chest. Jun 2013;143(6):1791-1795

Reference #3: Lee P, Culver DA, Farver C, Mehta AC. Syndrome of iron pill aspiration. Chest. Apr 2002;121(4):135

DISCLOSURE: The following authors have nothing to disclose: Monali Patil, Arjun Mohan, Kassem Harris

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