Foreign Body in the Airway Mimicking Tumour in an Adult: A Case Report

Abstract

Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.

Keywords: bronchoscopy; empyema of the chest; foreign body aspiration; high-frequency ventilation; intensive care.

Figure 1. Axial and coronal CT image of the lung with intravenous contrast on 8 April 2019 revealing a calcifying lesion in right main bronchus (blue arrows) and pleural effusion (red arrows)

Figure 2. High-frequency ventilation (blue arrow) during bronchoscopic extraction of the foreign body

Figure 3. The endobronchial FB (chicken bone) extracted via flexible fiberoptic bronchoscopy together with endotracheal tube (diameter of the FB was larger than the diameter of endotracheal tube).

FB - foreign body

Figure 4. Coronal and axial CT image of the lungs without intravenous contrast on 10 April 2019 after extraction of the foreign body revealing persistent atelectasis and pleural effusion (red arrows).

Figure 5. Chest X-ray on 14 August 2019