Inhaled foreign body

Case contributed by Dr Jane McEniery

Presentation

2 month history of persistent wheeze.

Patient Data

Age: 3 years
Gender: Female
X-ray

On the inspiratory phase image there is subtle asymmetry in density of the hemithoraces, with the right hemithorax appearing slightly more lucent than the left. There is no focal consolidation or pleural effiusion. No radio opaque foreign body is seen.
On the expiratory phase image the asymmetry is more pronounced. The left lung appears
more dense, whereas the right lung remains hyperlucent. 
This is highly concerning for an aspirated foreign body in the right main bronchus.

Case Discussion

An aspirated foreign body (a fragment of an almond) and associated granulation tissue was retrieved from the right main bronchus via bronchoscopy.

HISTOLOGY
MACROSCOPIC
Granulation tissue right bronchus: Two pieces of thin tan tissue 3x2x1mm and
10x7x1mm.  

MICROSCOPIC
Granulation tissue right bronchus: There is a slightly polypoid piece of
mucosa partially covered by stratified squamous epithelium and partially by
ciliated respiratory epithelium. There is reactive squamous metaplasia.
In the submucosa there is a moderate mixed, chronic and acute inflammatory cell infiltrate comprisingplasma cells, lymphocytes, neutrophils and eosinophils.
Also included in the specimen are pieces of plant matter. 

SUMMARY
Granulation tissue right bronchus: Polypoid mucosa with moderate inflammation.
Plant matter.

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