A CASE OF TURBAN PIN INHALATION SYNDROME IN A YOUNG WOMAN

Abstract

TOPIC: Cultural Diversity TYPE: Medical Student/Resident Case Reports INTRODUCTION: Turban Pin Inhalation Syndrome (TPIS) is mainly reported in countries in the Middle East with increased prevalence in younger females [1]. Incidences can be found in diverse cultural populations such as intercity areas like New York City. CASE PRESENTATION: A 38 year old woman with no past medical history presents to the emergency room an hour after accidentally inhaling a hair pin. Patient sensed something stuck in her throat and admitted to persistent hoarseness. Patient denies radiating pain, shortness of breath, chest pain, or hemoptysis. Physical exam reveals normal vitals. Patient is sitting comfortably with no respiratory distress, wheezing, drooling, or stridor. X-ray reveals a pin in the left main bronchus without pneumothorax or pneumomediastinum. After obtaining informed consent for flexible bronchoscopy, the patient was intubated and the pin was removed with three pronged forceps via flexible bronchoscopy in the emergency room (ER). Patient was discharged directly from the ER after successful extubation. DISCUSSION: Patients with TPIS usually present to the ER after accidentally inhaling pins held in their mouth while adjusting their scarves. Patients experience a brief episode of intense coughing and a feeling of suffocation, which is known as penetration syndrome. Patients are typically asymptomatic shortly afterwards, which leads to delay in seeking treatment. Early intervention is important because of the risk of distal mobilization or penetration through the bronchial wall or lung parenchyma leading to pneumothorax or pneumomediastinum. The average time between inhalation and surgery is 10 days. Longer term complications include granuloma formation into bronchial tree, recurrent pneumonia, obstructive emphysema, pleural effusion, bronchiectasis, and pulmonary abscess. Diagnosis is confirmed via X-ray that shows a linear opacity. In some reports, pins are located in the right main bronchus, but in other studies, there is no predilection for either side [1]. Rigid bronchoscopy is the standard modality to retrieve the pin, but would require removal in the operating room [1, 2, 3]. Flexible bronchoscopy can be used to retrieve the foreign body inhalation at bedside, which saves time and is more efficient in terms of logistics. If physicians are unable to retrieve the pin via bronchoscopy, more invasive measures would be used to retrieve the pin such as thoracotomy or parenchymal resection. CONCLUSIONS: Incidences of TPIS are not only in the Middle East, but also can be found in multi-cultural areas. These patients can present to intercity hospitals where they can undergo pin removal via flexible bronchoscopy and can be discharged the same day from the ER. REFERENCE #1: N. Rizk, N.E. Gwely, V.L. Biron, U. Hamza. Metallic hairpin inhalation: a healthcare problem facing young Muslim females. J Otolaryngol Head Neck Surg, 43 (2014 Aug 2), p. 21 REFERENCE #2: O. Ilan, R. Eliashar, N. Hirshoren, K. Hamdan, M. Gross. Turban pin aspiration: new fashion, new syndrome. Laryngoscope, 122 (4) (2012 Apr), pp. 916-919 REFERENCE #3: O. Dikensoy, C. Usalan, A. Filiz. Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J, 78 (2002), pp. 399-403 DISCLOSURES: No relevant relationships by Amanda Eng, source=Web Response No relevant relationships by rattan patel, source=Web Response