A tale of three aspirations: foreign bodies in the airway

Abstract

Tracheobronchial foreign body aspiration is a serious medical problem, with clinical manifestations ranging from acute asphyxiation to insidious lung damage, as demonstrated by the three presented cases. Patient 1 aspirated during dinner, emergency bronchoscopy retrieved pieces of food, and she fully recovered the following day. Patient 2 presented with recurrent pneumonia and a right lower lobe lung abscess. After right lower lobectomy, pathology revealed a foreign object in the right main stem bronchus, a peanut aspirated one year earlier. Patient 3 became unresponsive several days after spinal surgery. The differential diagnosis included myocardial infarction, stroke, and foreign body aspiration. The patient died and necropsy revealed a foreign body in the right main stem bronchus (cooked meat). Thus, foreign body aspiration is not always suspected clinically, and the pathologist may play an important role in making the diagnosis. Histological identification of the aspirated material may be necessary for definitive diagnosis. Therefore, sections of commonly aspirated foods are presented, together with a 10 year history of aspirated objects received by this institution's surgical pathology department.

Figure 1

Retrieved bronchial specimen (chicken) in patient 1. Note the degenerated muscle fibres with lack of prominent cross striations and nuclei (haematoxylin and eosin stained).

Figure 2

(A) The foreign object identified in the bronchus of patient 2. Patient history suggests this object was a peanut M&M® (haematoxylin and eosin stained). The patient’s specimen was compared with sections of a known formalin fixed peanut M&M® (B) for accurate identification. The chocolate candy coating was dissolved in formalin before sectioning, leaving only the peanut centre, seen above. Note the numerous hyaline globules within the cells (haematoxylin and eosin stained).

Figure 3

(A) A section from the bronchial foreign body in patient 3, comprising necrotic smooth and skeletal muscle with numerous admixed yeast forms, consistent with cooked meat (haematoxylin and eosin stained). (B) Smaller muscle fragments and acute inflammation were identified within this patient’s alveoli (haematoxylin and eosin stained).

Figure 4

Lentil bean with nutrient material (starch) in cell compartments (haematoxylin and eosin stained).

Figure 5

(A) Blueberry and (B) watermelon seeds (haematoxylin and eosin stained). After sectioning, each seed consisted mainly of an outer shell (shown) with most of the centre being empty. Note the blue/purple pigmented plastids in the blueberry.

Figure 6

Hotdog with degenerated muscle tissue (arrow) and plant material (arrowhead) admixed with fat and connective tissue (haematoxylin and eosin stained).