Foreign body in bronchus

Case contributed by Dr Jose R Zuniga


Persistent cough for 3 months after eating chicken and swallowing a bone.

Patient Data

Age: 50 years
Gender: Male

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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