A 15-Year Occult Foreign Body in the Subglottic Area of A 50-Year-Old Woman

Abstract

Objective:
 To present a case of subglottic foreign body (FB) impaction in a 50-year-old woman diagnosed with bronchial asthma for 15 years.
 Methods:
 Design: Case Report
 Setting: Tertiary Public Hospital
 Patient: One
 Results: A 50-year-old woman with recurrent cough and dyspnea for 15 years that had been managed as bronchial asthma, developed stridor and halitosis in the last 5 years. Flexible laryngoscopy revealed a subglottic mass and CT scan confirmed a suspicious foreign body in the lumen of the subglottis. Signs and symptoms resolved after peroral endoscopic removal of the foreign body from the larynx. Histopathology of the extracted material from the airway confirmed it to be “bone tissue.”
 Conclusion: Foreign body aspiration can occur in adults without predisposing factors. Its diagnosis can be challenging as it can mimic respiratory disorders such as bronchial asthma. Endoscopy and computed tomography are valuable for correct diagnosis and management. An incorrect initial diagnosis should be considered in the light of unresolved symptoms and prompt referral to an appropriate specialist may prevent undue suffering and dangerous complications.
 Keywords: foreign body aspiration, occult airway foreign body

Clinicodemographic Profile and Treatment Outcomes of Patients with Upper Aerodigestive Tract Foreign Bodies in the Southern Philippines Medical Center: A Five-Year Retrospective Review

“…4 CT is only requested if the foreign body is radiolucent, radiography is not helpful, and we need additional critical information to manage complex cases. 9 Both cases that used CT scans had whistle impaction, which was not radiographically visualized, and no indirect signs were appreciated on plain radiographs. Despite these available diagnostic modalities, endoscopy is still the gold standard since it is performed for both diagnosis and treatment.…”

“…4 Asymptomatic patients with a negative history of witnessed aspiration or ingestion pose a concern as shown by Laks and Barzilay, where asymptomatic patients led to delays in the diagnosis, especially in children who can't express themselves. 9 Only those with a positive history of witnessed aspiration or ingestion did not pose a diagnostic dilemma despite not presenting any signs or symptoms. 9 Delays in diagnosis and treatment can result in potentially fatal consequences.…”

“…9 Only those with a positive history of witnessed aspiration or ingestion did not pose a diagnostic dilemma despite not presenting any signs or symptoms. 9 Delays in diagnosis and treatment can result in potentially fatal consequences. Clinical history, physical examination, and radiographic examinations are used to make decisions in these circumstances.…”

“…Despite these available diagnostic modalities, endoscopy is still the gold standard since it is performed for both diagnosis and treatment. 9 Extraction is the definitive treatment of foreign body impaction in the upper aerodigestive tract using rigid and flexible bronchoscopes. 3,4 Once the diagnosis is made, foreign bodies that have become arrested in the esophagus should be removed since they are unlikely to pass on their own.…”

“…A thoracotomy is an option in cases of endoscopic failure. 9 Although both flexible and rigid endoscopy have been used with excellent success and low complication rates to remove esophageal foreign bodies, flexible endoscopy can be conducted under local anesthetic and is a less timeconsuming treatment. 10 In our study, all cases of foreign body ingestion underwent rigid esophagoscopy.…”