Bronchial Stenosis Following Ferrous Sulfate Aspiration

Abstract

Aspiration of ferrous sulfate tablets is a rare and potentially serious condition that can lead to permanent airway stenosis. Diagnosis may be difficult, as presentation often includes nonspecific symptoms. Disease progression and treatment courses have been detailed in a limited number of publications. Herein, we report a case of severe bronchial stenosis that developed following aspiration of a ferrous sulfate tablet. To the best of our knowledge, this is the first reported attempt of laser fulguration to correct ferrous sulfate-induced bronchial stenosis.

Iron pill aspiration: Cytologic and histologic findings of a potential life‐threatening airway injury. A Case report and literature review

“…In only 50% of the cases the aspiration event was noticed by the patient or recalled after a detailed clinical history taken retrospectively. 6,7,[9][10][11]13,14,19,22,23,27 The most frequent symptoms in the acute phase, defined as the first two weeks after the aspiration event, where coughing (53%), four patients presented with brown sputum and eight with obvious hemoptysis. 12,13,19,20,23,25 Two cases presenting with hemoptysis were fatal due to massive lung haemorrhage.…”

“…Histologically, iron pill injury is characterized by the presence of crystalline iron fibrils involved by necrotic epithelium or in an ulcer base. Occasionally, an endoscopic polypoid appearance is found in upper gastrointestinal tract samples from those patients …”

“…[3][4][5] Iron pill aspiration events can occur unbeknownst to the patient and produce only relatively non-specific symptoms in the acute phase, such as chronic cough and wheeze. 6 Therefore, the recognition of its morphologic aspects is critical to its diagnosis and timely treatment, in order to prevent complications.…”

Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet

“…Aspiration of a ferrous sulfate tablet is a medical emergency that requires prompt recognition and removal because ferrous sulfate rapidly dissolves within the airway and produces substantial mucosal inflammation, necrosis, and potentially severe bronchial stenosis 10 11 12 . Clinically, a detailed history is important for diagnosing aspiration of a ferrous sulfate tablet.…”

“…The diagnosis can be confirmed by a bronchoscopic examination and tissue biopsy. The common findings are airway inflammation, necrosis, and ulceration of the involved bronchial mucosa 10 11 12 14 . These finding are caused by the oxidation of ferrous sulfate, resulting in the local production of cytotoxic oxidants and free radicals.…”