Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child

Abstract

We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation.

Keywords: Case report; Child; Cryotherapy; FB, foreign body; FBA, foreign body aspiration; Flexible bronchoscopy; Foreign body aspiration; Granulation tissue.

Fig. 1

Bronchoscopy image of inhaled foreign body (cuttlefish) in the left lower lobe with granulation tissue formed.

Fig. 2

A: Flexible bronchoscopic image showing cryotherapy applied to ablate the residual granulation tissue. B: Biopsy forceps applied to trim off the FB.

Fig. 3

Flexible bronchoscope image taken two months after removal of the foreign body and illustrating no complications. A: The entrance to the lateral segmental bronchus (B9). B: The subsegment B9b, where it was the foreign body and the granulation tissue.