Presentation
Persistent cough for 3 months after eating chicken and swallowing a bone.
Patient Data
- Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
A calcium density structure is located in the left main bronchus, with morphology consistent with a bone, specifically a "lucky bone".
Thickening of the bronchial walls to which the bone is attached.
No atelectasis or mucus plug is seen.
Case Discussion
Foreign bodies in airway (FBA) are rare in adults, and much more common in children. They are usually located in the right main bronchus, because of its more vertical orientation. In many cases, the moment of the aspiration is not remembered. FBA may be in place for months before being diagnosed, and can produce complications such as infections (pneumonia and abscess), chronic coughing, hemoptysis, bronchial stenosis and atelectasis.
Chest x-rays can detect less than 20% of foreign bodies, but may detect indirect findings in about 42% of the cases, such as hyperinflation. CT remains the ideal test when suspected.
Foreign bodies can be organic or inorganic, with the latter tending to be non-retrievable by endoscopy because they tend to induce more inflammation and granulation tissue regionally.
The first line in management is bronchoscopy, and surgery remains for complicated cases in which it is not possible to remove the object by a less invasive method, or when there are complications like abscesses, stenosis or bronchiectasis.
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