Abstract Introduction Foreign body aspiration (FBA) in adults is uncommon and typically occurs in individuals with altered airway anatomy or impaired protective reflexes. In patients with chronic tracheostomy, FBA is particularly rare but can rapidly lead to airway compromise or infection if not promptly addressed. We present a case of metallic brush aspiration through a Montgomery tracheostomy tube, successfully managed with bronchoscopic retrieval. Case Presentation A 54-year-old man with a history of congestive heart failure, type 2 diabetes mellitus, COPD, asthma, morbid obesity, and a chronic Montgomery tracheostomy presented after accidentally aspirating a tracheostomy cleaning brush. While cleaning his trach, the metallic brush broke off and entered the airway. He developed immediate coughing with frothy, blood-tinged sputum but denied shortness of breath or frank hemoptysis. He was placed on 5 L of oxygen via trach collar and saturating at 93%. Chest radiography demonstrated a 7.2 cm radiopaque linear foreign body extending from the carina into the right main bronchus. He was transferred to the ICU for further management. His Montgomery T-tube was replaced with a 6 mm Shiley tracheostomy tube to facilitate a bedside bronchoscopy. The bronchoscopy confirmed the metallic brush lodged within the right mainstem bronchus with the handle extending approximately 1 cm above the carina. Using forceps, the handle was grasped and successfully removed through the patient’s tracheostomy. The patient’s respiratory status remained stable post-procedure, and he was discharged with outpatient follow-up. Discussion Foreign body aspiration through a tracheostomy is an unusual complication, typically resulting from self-care activities such as suctioning or cleaning. The Montgomery T-tube, while beneficial for airway patency and phonation, can predispose patients to aspiration due to its open configuration and absence of upper airway protection. Radiographic imaging and bronchoscopy remain the diagnostic and therapeutic mainstays. Prompt retrieval of the foreign body is crucial, as delayed removal can lead to granulation tissue formation and, in severe cases, may necessitate surgical intervention such as thoracotomy. Prompt retrieval minimizes risks of airway obstruction, bleeding, or infection. Preventive strategies, including patient education on proper tracheostomy care and use of appropriate cleaning devices, are essential to reduce recurrence and improve long-term outcomes This abstract is funded by: None
Reddy et al. (Fri,) studied this question.