SESSION TITLE: Tales in BronchoscopySESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/19/2022 12:45 pm - 1:45 pmINTRODUCTION: Our rare case highlights the successful removal of a fully intact aspirated tweezer without residual complications because of prompt bronchoscopy-mediated extraction. This case highlights the value of prompt evaluation and urgent flexible bronchoscopy in mitigating complications in patients with large foreign body aspirations, particularly in patients with tracheal stomas open to the environment.CASE PRESENTATION: A 68-year-old male with a medical history of COPD, invasive squamous cell carcinoma of larynx status post laryngectomy and pharyngo-cutaneous fistula (PCF). He presented to the emergency department without symptoms but had witnessed a self-inflicted aspiration of a foreign body. The patient reported aspirating an intact tweezer while attempting to clean his stoma. He denied any shortness of breath, cough, or wheezing. Vitals on arrival were stable and he required no oxygen supplementation throughout his stay. Laboratory results were unremarkable. Chest x-ray (CXR) revealed a foreign body in the right mainstem (Figures 1 and 2). The patient underwent general anesthesia and was intubated via the stoma. A flexible bronchoscope was introduced through his PCF, which showed a large metallic foreign body in bronchus intermedius extending from right mainstem bronchus to the right lower lobe (Figure 3). Foreign body was successfully extracted with rat-tooth endobronchial forceps. En block removal of foreign body, bronchoscope and endotracheal tube was accomplished. He recovered without complications and was discharged home the same day.DISCUSSION: Foreign body aspiration is a rare phenomenon for adults. Adults present with non-specific symptoms like dyspnea, hemoptysis, productive cough, and rarely choking (1). Presentation is often misdiagnosed, leading to increased morbidity and mortality (2). In adults, the most common aspirated matter includes bones, seeds, and iatrogenic foreign bodies. Our case is only the third of its kind and further unique in that a sharp metal tweezer was aspirated fully into the airway without subsequent damage to the internal airway. Moreover, our patient had no respiratory symptoms on presentation. His self-reported aspiration prompted quick evaluation and prevented further complications. Flexible bronchoscopes are used in children for foreign-body extraction using topical lidocaine and general anesthesia is used for removal via forceps or basket. Flexible bronchoscopy is less commonly used in adult populations compared to children (3). Our case demonstrates the success of using prompt flexible bronchoscopy to safely extract large foreign bodies in adults without complications.CONCLUSIONS: This case highlights the value of using careful flexible bronchoscopy as first line treatment for some large foreign body extraction (e.g., a set of tweezers) in adult patients with open stomas with resulting ease of extraction and prompt resolution of symptomatology.Reference #1: Chung-Hua Chen, Chun-Liang Lai, Tsung-Tsung Tsai, Yu-Chin Lee, Reury-Perng Perng, Foreign Body Aspiration Into the Lower Airway in Chinese Adults, Chest, Volume 112, Issue 1, 1997, Pages 129-133, ISSN 0012-3692, https://doi.org/10.1378/chest.112.1.129. (https://www.sciencedirect.com/science/article/pii/S001236921547151X)Reference #2: Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990;112:604–9Reference #3: Ng J, Kim S, Chang B, et al. . Clinical features and treatment outcomes of airway foreign body aspiration in adults. J Thorac Dis 2019;11:1056–64.DISCLOSURES: No relevant relationships by Obaid AshrafNo relevant relationships by Marvin Balaanno disclosure on file for Aarthi Ganesh;No relevant relationships by Adeel NasrullahNo relevant relationships by Aaisha Shah SESSION TITLE: Tales in Bronchoscopy SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Our rare case highlights the successful removal of a fully intact aspirated tweezer without residual complications because of prompt bronchoscopy-mediated extraction. This case highlights the value of prompt evaluation and urgent flexible bronchoscopy in mitigating complications in patients with large foreign body aspirations, particularly in patients with tracheal stomas open to the environment. CASE PRESENTATION: A 68-year-old male with a medical history of COPD, invasive squamous cell carcinoma of larynx status post laryngectomy and pharyngo-cutaneous fistula (PCF). He presented to the emergency department without symptoms but had witnessed a self-inflicted aspiration of a foreign body. The patient reported aspirating an intact tweezer while attempting to clean his stoma. He denied any shortness of breath, cough, or wheezing. Vitals on arrival were stable and he required no oxygen supplementation throughout his stay. Laboratory results were unremarkable. Chest x-ray (CXR) revealed a foreign body in the right mainstem (Figures 1 and 2). The patient underwent general anesthesia and was intubated via the stoma. A flexible bronchoscope was introduced through his PCF, which showed a large metallic foreign body in bronchus intermedius extending from right mainstem bronchus to the right lower lobe (Figure 3). Foreign body was successfully extracted with rat-tooth endobronchial forceps. En block removal of foreign body, bronchoscope and endotracheal tube was accomplished. He recovered without complications and was discharged home the same day. DISCUSSION: Foreign body aspiration is a rare phenomenon for adults. Adults present with non-specific symptoms like dyspnea, hemoptysis, productive cough, and rarely choking (1). Presentation is often misdiagnosed, leading to increased morbidity and mortality (2). In adults, the most common aspirated matter includes bones, seeds, and iatrogenic foreign bodies. Our case is only the third of its kind and further unique in that a sharp metal tweezer was aspirated fully into the airway without subsequent damage to the internal airway. Moreover, our patient had no respiratory symptoms on presentation. His self-reported aspiration prompted quick evaluation and prevented further complications. Flexible bronchoscopes are used in children for foreign-body extraction using topical lidocaine and general anesthesia is used for removal via forceps or basket. Flexible bronchoscopy is less commonly used in adult populations compared to children (3). Our case demonstrates the success of using prompt flexible bronchoscopy to safely extract large foreign bodies in adults without complications. CONCLUSIONS: This case highlights the value of using careful flexible bronchoscopy as first line treatment for some large foreign body extraction (e.g., a set of tweezers) in adult patients with open stomas with resulting ease of extraction and prompt resolution of symptomatology. Reference #1: Chung-Hua Chen, Chun-Liang Lai, Tsung-Tsung Tsai, Yu-Chin Lee, Reury-Perng Perng, Foreign Body Aspiration Into the Lower Airway in Chinese Adults, Chest, Volume 112, Issue 1, 1997, Pages 129-133, ISSN 0012-3692, https://doi.org/10.1378/chest.112.1.129. (https://www.sciencedirect.com/science/article/pii/S001236921547151X) Reference #2: Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990;112:604–9 Reference #3: Ng J, Kim S, Chang B, et al. . Clinical features and treatment outcomes of airway foreign body aspiration in adults. J Thorac Dis 2019;11:1056–64. DISCLOSURES: No relevant relationships by Obaid Ashraf No relevant relationships by Marvin Balaan no disclosure on file for Aarthi Ganesh; No relevant relationships by Adeel Nasrullah No relevant relationships by Aaisha Shah