Lord of the (Magnetic) Rings: Rigid Bronchoscopy for Aspirated Magnetic Foreign Bodies in Tertiary Bronchi

Abstract

ObjectivesTo describe operative techniques using rigid bronchoscopy and ferromagnetic bronchoscopic equipment to retrieve magnetic foreign bodies in distal tertiary bronchi beyond the reach of traditional optical instrumentation.MethodsA 13‐year‐old presented to the Emergency Department following aspiration of three backing magnets from a magnetic nose ring. Chest radiographs demonstrated a 4 mm × 3 mm foreign body in the right lower lobe 0.5 cm from diaphragm on expiratory film. She was taken to the operating room for removal of an airway foreign body.ResultsThe foreign body was visualized with direct laryngoscopy followed by rigid bronchoscopy in the distal right lower tertiary bronchus. Attempts to pass optical instruments were limited both by distance of the object and size of instrumentation compared to the diameter of the tertiary bronchus. A salivary wire basket and ureteral stone retrieval basket were then passed with endoscopic visualization into the tertiary bronchus but were unable to engage the foreign body. An attempt was made to pass a 2 French Fogarty embolectomy catheter distally, but the catheter was too large to bypass the foreign body. Finally, ferromagnetic pulmonary rat tooth biopsy forceps were advanced into the tertiary bronchus and successfully attracted the magnetic foreign body for safe removal through our rigid bronchoscope.ConclusionWe present a novel method of utilizing ferromagnetic flexible bronchoscopic instruments to safely remove magnetic foreign bodies in the tertiary bronchi beyond the reach of traditional bronchoscopic instruments. Laryngoscope, 2024