Abstract Background Foreign body (FB) aspiration is an uncommon but potentially life-threatening event in adults. FB aspiration accounts for only 0.16-0.33% of adult bronchoscopy procedures (1), and the literature reports a low prevalence of FB aspiration in adults (0.66 per 100,000) (2). Adult FB aspiration typically presents with a choking event with persistent coughing, but can mimic chronic diseases such as COPD, asthma, and obstructive pneumonia, especially in elderly patients with altered mental status (AMS) (1). We present a case of FB aspiration in a young adult that was successfully removed using a novel endoscopic approach. Case Description A 39-year-old man was found down and brought to the ER for severe respiratory depression and altered mental status, raising concerns for opioid overdose. GCS of 3 noted on arrival without improvement after Narcan administration. He was subsequently intubated in the ED for airway protection. CXR demonstrated left pulmonary infiltrates, and follow-up CT chest showed a radiopaque FB within the left mainstem bronchus (Fig.1). Initial bronchoscopy showed a solid, brown FB surrounded by mucous that was partially blocking the left main stem bronchus (Fig. 2). A repeat bronchoscopy was performed the following day with plans to remove the FB. Multiple techniques were attempted, including the use of an endoscopic net, forceps, and snare tool. The initial attempt with the net was unsuccessful due to difficulty maneuvering it around the FB. Forceps were then used but repeatedly slipped and failed to capture the entire FB. Finally, a snare was successfully looped around the FB; however, the snare-FB complex was too large to be extracted through the endotracheal tube (ETT). Several attempts were subsequently made to remove the FB by holding it against the ETT during extubation, which ultimately succeeded. The FB was identified as a stone measuring up to 3 cm in diameter (Figure 3). Conclusion Removal of a foreign body can be challenging, and this difficulty is compounded when its size exceeds the endotracheal tube diameter. While surgical approaches have been used historically (3), this case highlights a unique endoscopic technique for successful bronchial FB extraction with careful planning, persistence, and adaptation of available tools. This abstract is funded by: None
Malhi et al. (Fri,) studied this question.