KERNEL OF TRUTH: AN INTERESTING CASE OF FOREIGN BODY ASPIRATION

Abstract

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Foreign body aspiration (FBA) is commonly seen in the pediatric and elderly population. Risk factors include encephalopathy, stroke, alcoholism and neuromuscular disorders affecting swallowing reflex. It is rare in the adult population except in cases of unconscious accidental ingestion. The most common symptom of FBA is chronic cough, which is nonspecific and can often be mistakenly approached as an infectious process. Here we describe a case of a patient who had no significant risk factors, presented with chronic cough and was found to have a lung mass on imaging but ultimately diagnosed with foreign body aspiration. CASE PRESENTATION: A 60-year-old male presented to the pulmonary office for a progressive productive cough of two-year duration. Chest roentgenogram (CXR) showed a dense opacification in the right middle lobe concerning for pneumonia versus obstructive lesion. He completed a 10-day course of levofloxacin but with no improvement of symptoms. He denied history of travel, sick contacts, pet exposure, or incarceration. He had intermittent febrile episodes and a twenty-pound weight loss. He was a non-smoker and didn’t drink alcohol. On physical examination, he had decreased breath sounds on the right lung field. Laboratory workup was significant for leukocytosis. Chest computed tomography showed complete opacification of the right middle lobe (RML) with abrupt cut off of the RML bronchus concerning for an obstructive mass along with subcarinal and right hilar lymphadenopathy (Figure 1). He underwent diagnostic bronchoscopy in which two yellow, spherical foreign body fragments were found to be obstructing the RML bronchus (Figure 2). Both specimens were removed successfully, and further gross examination was consistent with corn kernels. Bronchoalveolar lavage and endobronchial biopsies were negative for malignancy. After foreign body removal, patients' symptoms subsequently improved. DISCUSSION: FBA in the tracheobronchial tree is more common in the pediatric population than adults. Common risk factors in adults include advanced age, stroke, neuromuscular diseases such as myasthenia gravis, and alcohol abuse. Given the lack of such risk factors, prolonged duration of symptoms, and imaging concerning for malignancy, the diagnosis of FBA was not suspected. Undiagnosed FBA can lead to complications such as recurrent pneumonia, atelectasis, or bronchiectasis. Flexible bronchoscopy is the treatment of choice for the diagnosis and removal of FBA. CONCLUSIONS: Due to the predisposition for a delayed diagnosis of FBA in the healthy adult population, a high index of suspicion and thorough history taking is warranted when dealing with cases of chronic cough and recurrent pneumonia to avoid long term sequelae. Reference #1: Kam JC, et al. Foreign Body Aspiration Presenting with Asthma-Like Symptoms. Case Reports in Medicine. 2013;2013:1-4. Reference #2: Cataneo AJM, Reibscheid SM, Ruiz RL, Ferrari GF. Foreign Body in the Tracheobronchial Tree. Clinical Pediatrics. 1997;36(12):701-705. Reference #3: Malinowska E, Dabrowska-Kruszewska J, Doboszynska A, Stangiewicz M, Gugala K, Biernacki M. Foreign Body in the Airway a Female Patient with Myasthenia Gravis. Advances in Experimental Medicine and Biology Pathophysiology of Respiration. 2015:29-36. DISCLOSURES: No relevant relationships by Anthony Cucci, source=Admin input No relevant relationships by NICOLE LAO, source=Web Response No relevant relationships by Joseph Michael Lim, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response