Tracheal swab from front of neck airway for SARS-CoV-2; a bronchial foreign body

Abstract

We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. A qualified nurse was performing a routine SARS-CoV-2 swab on a 51-year-old woman, fitted with a tracheostomy in the recent past following a craniotomy. This was part of the discharging protocol to a nursing home. During the sampling, part of the swab stylet snapped and was inadvertently dropped through the tracheostomy site. Initial CT imaging was reported as showing no signs of a foreign body but some inflammatory changes. Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved.

Keywords: ear; medical-surgical nursing; nose and throat/otolaryngology; otolaryngology / ENT; radiology.

Figure 1

Sigma Virocult swab and stylet. The stylet snaps and the distal end is sent off in the vial.

Figure 2

Plain radiograph taken after inhalation of foreign body.

Figure 3

The coronal reformatted image shows slight narrowing of the bronchus at the same level as the axial images due to the foreign body (white arrowhead).

Figure 4

On lung windows, a soft tissue density is seen within the medial right lower lobe bronchus, just distal to the apical branch, across serial axial 1 mm CT slices. Two examples are provided 3 mm apart (white arrow).

Figure 5

On lung windows, a soft tissue density is seen within the medial right lower lobe bronchus, just distal to the apical branch, across serial axial 1 mm CT slices. Two examples are provided 3 mm apart (white arrow).