Foreign body in bronchus

Case contributed by Dr Jose R Zuniga

Presentation

Male, in his 50´s, presented with a history of persistent coughing for 3 months after eating chicken and swallowing a bone.

Patient Data

Age: 50´s
Gender: Male
CT

A calcium density structure is located in the left main bronchus, with morphology consistent with a bone, specifically note the morphology of a "lucky bone". There´s also 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 the adult, and much more common in children. When found in adults, they are usually located in the right main bronchus, because of its more vertical orientation, and require a high index of suspicion. 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 like infections (pneumonia and abscess), chronic coughing, hemoptysis, bronchial stenosis and atelectasis.

Chest x-ray can detect less than 20% of radio-opaque foreign bodies, and may detect indirect findings in about 42% of the cases, being hyperinflation the most common. CT remains the ideal test when suspected.

The foreign body 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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Case information

rID: 31033
Case created: 17th Sep 2014
Last edited: 11th Sep 2015
System: Chest
Inclusion in quiz mode: Included

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