Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

Abstract

An 84-year-old woman accidentally aspirated an iron tablet. She was successfully treated with early endobronchial removal of the iron tablet remnants, oral corticosteroids and antibiotics. We describe the bronchoscopic and histological changes over time following acute iron tablet aspiration and highlight the importance of early intervention to avoid complications.

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 . 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 . Two cases presenting with hemoptysis were fatal due to massive lung haemorrhage .…”

“…Seventeen cases included chest X‐ray description, out of which six presented normal immediately after the episode of aspiration . On chest X‐ray, the abnormalities observed were non‐specific.…”

Bronchial Stenosis Following Ferrous Sulfate Aspiration

“…[2][3][4][5][6][7][8][9][10]17 Ferrous sulfate is known to produce gastric erosion at therapeutic doses, and crystalline iron deposits have been isolated in damaged mucosal tissue. [2][3][4][5][6][7][8][9][10]17 Ferrous sulfate is known to produce gastric erosion at therapeutic doses, and crystalline iron deposits have been isolated in damaged mucosal tissue.…”

“…[2][3][4][5][6][7][8][9][10]17 In the acute setting, the involved bronchial epithelium can be lined with a brown necrotic material. The presence of inflammation, necrosis, and ulceration of the bronchial mucosa is common to prior descriptions.…”

“…The presence of inflammation, necrosis, and ulceration of the bronchial mucosa is common to prior descriptions. 4,5,9 In 2 cases, biopsies were taken 9 to 12 months following aspiration; both reported marked fibrosis and relatively minimal active inflammation. 2,8,17,20 Endobronchial biopsy of the involved mucosa is essential for proper diagnosis as ferrous sulfate rapidly dissolves leaving no evidence of tablet aspiration.…”