Bronchoscopic Removal of a Long-standing Aspirated Iron Pill

Abstract

While patients have been known to aspirate pills, they virtually never persist long enough to lead to complications. A spectrum of events, however, may arise especially from iron pill aspiration. If not identified and removed early, cytotoxic damage from local free-radical generation may result in airway damage. We report a case of an aspirated iron pill, which did not disintegrate and presented with chronic cough. Imaging revealed a foreign body in the right bronchus, and bronchoscopic removal allowed resolution of an associated pneumonia, without any further symptoms on subsequent surveillance.

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

“…The second most common symptom was dyspnoea and choking presented by 13 patients. Other less common symptoms were pleuritic pain and burn sensation, reported in six cases, and epigastric discomfort …”

“…The mean age was of 68.5 years (range of 36–92 years). 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 .…”

“…The most common was atelectasis, followed by lung condensation and patchy opacifications. Suspicious images for foreign body were documented in three chest‐CT scan images, described as high density or nodular material in the bronchial lumen …”

“…Bronchoscopy examinations performed in the acute phase, consistently revealed a yellow‐brown discolored, necrotic mucosa, occasionally forming a polypoid mass, markedly friable with easy bleeding when touched . Necrosis, inflammation, and pigments were reported to last up to two months …”

“…In eight cases, it was still possible to identify and remove the pill through bronchoscopy, thereby preventing complications . In the chronic phase, the most commonly reported complications were bronchial stenosis and lung atelectasis.…”