Pill Aspiration Research Articles

Airway Injury Caused by Aspiration of Iron Sulfate Pills: A Series of 11 Cases

It is not widely recognized that iron (ferrous sulfate) pill aspiration causes airway damage. Clinical diagnosis is challenging because patients are often unaware that they have aspirated a pill. The literature on this entity consists mainly of case reports. The aim of this study is to describe the clinical and pathologic features of iron pill aspiration in a series of 11 patients. A retrospective review of our pathology archives was performed to identify cases of iron pill aspiration (2013-2023). All available histologic and cytologic material was rereviewed. Clinical information was collected from the electronic medical record, and imaging studies were rereviewed. Eighteen endobronchial biopsies were identified from 11 patients (7 women and 4 men; mean age, 70 years; range, 44-82 years). Eight patients had corresponding cytology (20 specimens). Medication history was available in 9 of 11 patients, all of whom were taking iron sulfate pills. Two patients reported possible aspiration episodes; 4 had risk factors for aspiration. The diagnosis of iron pill aspiration was suspected prior to biopsy in only 1 case. Histologically, iron pill particles were yellow, golden brown, or gray, were elongated and crystal or fiber like, and stained strongly with an iron stain. Common histologic findings included mucosal ulceration, acute and/or chronic inflammation, fibrosis, and squamous metaplasia. Iron pill particles were also identified in 11 cytology specimens from 6 patients. On Papanicolaou staining, iron pill particles were yellow to golden, fiber like, refractile, and crystalline. Reactive epithelial cells, squamous metaplasia, and acute inflammation were common. The combination of iron pill intake and discolored mucosa on bronchoscopy is a potential clue to the diagnosis of iron pill aspiration. Pathologists should familiarize themselves with the appearance of iron pill particles in endobronchial biopsies and cytology specimens from the respiratory tract as this diagnosis is seldom suspected on clinical grounds, and most patients lack a history of aspiration.

Pill Pneumonitis Induced By Pill Aspiration: A Case Report, Diagnosis and Management

Pill Pneumonitis Induced By Pill Aspiration: A Case Report, Diagnosis and Management

PILL-INDUCED PNEUMONITIS PRECIPITATING GROSS HEMOPTYSIS BY ASPIRATED ANTICOAGULANT MEDICATION

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pill pneumonitis (PP) is described as pulmonary inflammation and fibrosis secondary to the aspiration of pills. Those having dysphagia are at the highest risk for aspiration include neurologic impairment, anatomic deformity, and oropharyngeal dysfunction. The epidemiology of this condition is ill-defined to date given the scarcity of its diagnosis. Herein, we present a unique case of pill pneumonitis secondary to anticoagulant aspiration leading to gross hemoptysis. CASE PRESENTATION: A 26-year-old male, with a 2-year remote history of MVA complicated by right upper extremity DVT on Rivaroxaban, presented with a two-day history of gross hemoptysis with concurrent cough and dyspnea. PMH is otherwise unremarkable. The patient recalled choking a few days prior on his medications. Upon presentation, he had stable vital signs and a physical exam remarkable for mild left-sided rales.Laboratory workup demonstrated no leukocytosis and no significant change in hemoglobin. CT angiogram demonstrated peribronchial patchy consolidation with scattered ground-glass opacities; With reactive mediastinal and hilar lymphadenopathy. The patient was admitted for evaluation of new-onset hemoptysis and a subsequent bronchoscopy discerned diffuse patchy erythematous friable mucosa with foreign body particulates, most notably in the left mainstem bronchus. Otherwise, all accompanying testing was unyielding included infectious and autoimmune panels and tissue biopsies. The patient's Rivaroxaban was discontinued and the Ultrasound of the upper extremity showed no evidence of DVT. He received a course of steroids and antibiotics. The patient's gross hemoptysis resolved by the second day of hospitalization. DISCUSSION: PP is a serious complication to FBA and the acute onset of cough, wheezing, and dyspnea should raise suspicion in patients without other suggestive causes. These include pneumonia, congestive heart failure, or trauma. This case is noteworthy due to the patient's aspiration of an anticoagulant leading to an acute onset of pill pneumonitis with significant gross hemoptysis. A high degree of suspicion is needed to initiate early and aggressive diagnostic and interventional treatment, and the threshold of suspicion should be lowered in patients with a greater risk of aspiration. Our patent did not have risk factors for dysphagia, however, unnecessary use of anticoagulant therapy led to the acute progression of this patient's clinical presentation. Furthermore, management of pill pneumonitis is based on early and aggressive bronchoalveolar lavage and foreign body removal, which has shown to reduce disease progression and reverse inflammatory changes. CONCLUSIONS: This case describes a novel cause of PP, as no previous case describes aspiration of anticoagulant medication and emphasizes the importance of early diagnosis and proper anticoagulant use as a means of preventing unforeseen complications. REFERENCE #1: Hill, S. N., Main, A. N., & Fuggle, W. J. (1988). Covert inhalation of tablet causing fatal pneumonia. Postgraduate Medical Journal, 64(747), 66-67. doi:10.1136/pgmj.64.747.66 REFERENCE #2: Hu, X., Lee, J. S., Pianosi, P. T., & Ryu, J. H. (2015). Aspiration-related pulmonary syndromes. Chest, 147(3), 815-823. doi:10.1378/chest.14-1049 REFERENCE #3: Lee, P., Culver, D. A., Farver, C., & Mehta, A. C. (2002). Syndrome of iron pill aspiration. Chest, 121(4), 1355-1357. doi:10.1378/chest.121.4.1355 DISCLOSURES: No relevant relationships by Connor Kerndt, source=Web Response no disclosure on file for Shahid Mohammed; No relevant relationships by Mitchelle Zolotarevsky, source=Web Response

IRON PILL ASPIRATION MIMICKING ASTHMA

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Foreign body aspiration can be a life-threatening event. Aspiration of iron pill can cause significant bronchial destruction via necrosis. Iron pill quickly disintegrates in the airway, inducing deep mucosal necrosis responsible for severe complications if not diagnosed promptly. We report a case of iron pill aspiration with asthma like presentation leading to severe bronchial stenosis. CASE PRESENTATION: A 50-year-old nonsmoking female, with past medical history of hypertension and arthropathy was referred to pulmonology for wheezing and shortness of breath that started after she had accidentally aspirated an iron pill. Examination was significant for expiratory wheezing. X-ray of the chest was normal. Bronchoscopy performed for the removal of the iron pill revealed complete obstruction of the right lower lobe (RLL) bronchus with thick mucoid secretions coated in iron and granulation tissue. Follow up bronchoscopy showed similar findings which included severe persistent airway inflammation. Cultures obtained grew cryptococcus neoformans. For which patient was she was treated with oral Diflucan for 1 year. Pulmonary function test showed no evidence of restriction or obstruction Once the infection was fully treated patient underwent endobronchial ultrasound (EBUS) which was performed as a therapeutic intervention for the RLL lesion as patient still had persistent symptoms of wheezing. EBUS showed severe stenosis of the RLL which was relieved following CRE balloon-tipped catheter insertion into the stenotic segment of the lower trachea followed by local intralesional steroid injection. On follow up three months later patient reported significant improvement in her symptoms. DISCUSSION: Iron pill aspiration syndrome is a relatively rare cause of severe bronchial inflammation leading to endobronchial stenosis [1,2]. The diagnosis is made by the presence of history of aspiration, airway inflammation and iron deposition as noted on histopathology. Oxidation of iron pill can cause bronchial mucosal inflammation, ulceration and necrosis which progresses to bronchial narrowing and possibly irreversible stenosis [3]. Early diagnosis with bronchoscopy and treatment plays a crucial role in overall prognosis. Our case represents a remarkable recovery with balloon dilation and intralesional steroid injection resulting in relief of stenosis. CONCLUSIONS: •Physicians should be very prudent with prescribing iron pills in individuals who are at high risk of aspiration in order to avoid serious bronchial complications. •Prompt bronchoscopic intervention and management is required to prevent progression to serious complications. •Physicians should consider balloon dilation with intralesional steroid injection for patients with refractory symptoms after removal of the foreign object. REFERENCE #1: Caterino U., Battistoni P., Batzella S., Iacono R. Dello, Lucantoni G., Galluccio G. Syndrome of iron pill inhalation in four patients with accidental tablet aspiration: severe airway complications are described. Respir. Med. Case Rep. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501451/ REFERENCE #2: Management of Iron Pill Aspiration Syndrome: Advanced Bronchoscopic InterventionMonali Patil MD* Arjun Mohan MD; and Kassem Harris MD University at Buffalo, Buffalo, NY, https://journal.chestnet.org/article/S0012-3692(16)57346-2/pdf REFERENCE #3: The Iron Lung: When Iron Pill Aspiration Results in an Immediate Bronchoscopy. A Successful Medical Therapy to a Serious ConditionSarah Abuseif, Mohamed Elsawaf, Gustavo De La Luz, https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A5565 DISCLOSURES: No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Adel El Abbassi, source=Web Response No relevant relationships by Saman Saeed, source=Web Response No relevant relationships by Haniya Saeed, source=Web Response No relevant relationships by Dima Youssef, source=Web Response

PILL ASPIRATION: BRONCHOSCOPIC CHARACTERISTICS OF IRON ASPIRATION COMPARED TO OTHER PILLS

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pill aspiration is a rare but potentially serious event that can lead to airway damage. Case reports describe instances of iron pill aspiration, however series comparing iron and non-iron pill aspiration are lacking. Here we examined cases of pill aspiration managed with flexible bronchoscopy to describe the differences in clinical characteristics and degree of airway inflammation among patients aspirating iron and non-iron pills. METHODS: A single-center retrospective observational study was conducted at the Mayo Clinic in Rochester, MN. All cases of pill aspiration occurring between 2008 and 2020 were examined. Patient characteristics and bronchoscopy findings were gathered. The severity of inflammation was graded as mild, moderate, or severe based on the bronchoscopists’ operative notes. RESULTS: A total of 28 cases of pill aspiration were reviewed, nine of which were iron sulfate pill aspiration. Among the non-iron group, the various pills aspirated included magnesium sulfate, docusate, multivitamins, calcium carbonate, pantoprazole, nortriptyline, garcinia cambogia, and morphine. No definite identification of the pills could be made in nine cases, but was deemed to definitely not be iron based on the patients’ medication list. In the non-iron group, the mean age was 69 (SD = 16.8). 68% were female. The duration between the aspiration event and the bronchoscopy procedure was identified in 17 cases; the mean duration was 1.81 days (SD = 2.1). Pill material was visualized in 11 cases and in three of the cases, the entire pill was removed intact. 21% of the cases were noted to have severe inflammation and the remaining had mild or moderate inflammation as deemed by the operating bronchoscopists. In the iron group, the mean age was 72 (SD 9.6). 100% were female. The duration between aspiration and bronchoscopy was identified in seven cases; the mean duration was 2.28 days (SD = 2.3). Pill material was visualized in five cases. 78% of the cases were noted to have severe inflammation. Three of the cases had repeat bronchoscopy done one to four weeks after the initial procedure. All three cases were noted to have significant stenosis of the affected bronchi. CONCLUSIONS: Patients who suffer pill aspiration tend to be elderly and female. The iron group had a greater percentage of cases with severe inflammation even though the mean duration from aspiration to bronchoscopy was similar in the two groups, as was the percentage of cases where residual pill material was found. Currently published cases describing severe long term sequelae of pill aspiration typically had a longer delay between the aspiration event and intervention. CLINICAL IMPLICATIONS: Iron sulfate pill aspiration leads to a quicker and more intense inflammatory reaction compared to other pills. Early bronchoscopy is important as the pill material may be found and removed, thereby avoiding prolonged damage and long term complications. DISCLOSURES: No relevant relationships by Tyler Herzog, source=Web Response No relevant relationships by Harsha Mudrakola, source=Web Response No relevant relationships by Darlene Nelson, source=Web Response

MAGNESIUM OXIDE PILL ASPIRATION: CASE REPORT

SESSION TITLE: Medical Student/Resident Procedures SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pill aspiration is uncommon in adults, comprising 2.8% of foreign body aspirations. Symptoms and signs are nonspecific and chest x-rays can be normal in 25% of cases. It can cause airway obstruction, inflammation and stenosis leaving long-term sequelae. Having a high suspicion and doing bronchoscopy early is important in avoiding any long-term sequelae. Here we report a challenging case of bronchus obstruction by magnesium oxide pill aspiration. CASE PRESENTATION: A 60-year-old female presented to the emergency department (ED) at an outside hospital with irritation and cough after choking on a magnesium pill. Chest x-ray did not show any abnormalities so patient was discharged home with instructions to follow up with her primary care physician (PCP). Over the next 2-3 days, she had low-grade fever, coughing fits which brought up bits of the tablet and shortness of breath. She saw her PCP the next day and was given azithromycin. That night, she had a fever of 38.8C and came in to our ED. Vital signs were stable except for oxygen saturation of 91% on room air. She had decreased breath sounds on right mid-to-lower lung field. The remainder of her exam was unremarkable. Chest x-ray showed right middle lobe infiltrates. CT chest revealed a 9x9mm radio-opaque density in the right bronchus intermedius, scattered areas of ground glass opacities and atelectasis in the right middle lobe. She underwent flexible bronchoscopy that showed a white ball-like foreign body near-obstructing the right bronchus intermedius. Mucosa was edematous with mild inflammation, no necrosis or stenosis was noted. The foreign body was successfully removed with grasping forceps in a few smaller pieces (biggest 9 x 7 mm). They were hard, white and chalky, consistent with the magnesium oxide pill. The next day, she reported improvement in her cough and shortness of breath. Her oxygen saturation had improved to 96% on room air and she was discharged home in stable condition. DISCUSSION: Adult patients can present with a clear history of the aspiration event. Symptoms and signs are nonspecific and chest x-rays can be normal in 25% of cases, making the diagnosis challenging. Our patient felt the choking sensation and sought medical attention. Despite her history and due to normal chest x-ray and nonspecific symptoms of cough and normal vital signs, she was initially discharged home without further investigation. In the cases where patients remember a specific aspiration event, despite nonspecific symptoms and normal chest x-ray, further investigation with CT imaging or bronchoscopy should be sought. Left untreated it is possible that there may be further damage to the bronchus through inflammation. CONCLUSIONS: There has been no documentation of the effects of magnesium oxide pill aspiration on the bronchial mucosa. Early bronchoscopy with intervention to remove the pill is important in avoiding any long-term complications. Reference #1: Singh I, Dm S, Dm SD, Ram B. Foreign Body Inhalation in the Adult Population : Experience of 25 , 998 Bronchoscopies and Systematic Review of the Literature. 2015:1438-1448. https://doi.org/10.4187/respcare.03976. Reference #2: Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “ Pills ” and the Air Passages, A Continuum. Chest. 2015;147(1):242-250. https://doi.org/10.1378/chest.14-0531. Reference #3: Kinsey CM, Folch E, Majid A, Channick CL. Evaluation and Management of Pill Aspiration. CHEST. 2013;143(6):1791-1795. https://doi.org/10.1378/chest.12-1571. DISCLOSURES: no disclosure on file for Ji Hyun Rhee; No relevant relationships by Jack Tomen, source=Web Response

PILL ASPIRATION CAUSING ACUTE TRACHEOBRONCHIAL OBSTRUCTION RESEMBLING AN ENDOBRONCHIAL TUMOR

SESSION TITLE: Medical Student/Resident Procedures SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pill aspiration is a major cause of morbidity and mortality in elderly patients in whom an aspiration event may not be evident. Chest imaging has limited utilization as most pills are radiolucent. During surveillance bronchoscopy, a foreign body may not be seen, as pills can dissolve in the tracheobronchial tree causing obstruction, inflammation, fibrosis and airway stenosis. A high index of suspicion is required in adults presenting with respiratory symptoms. CASE PRESENTATION: A 73 year old woman presented to the hospital with non productive cough and shortness of breath for a few days. Her past medical history was significant for stroke with left-sided hemiplegia and seizure disorder on treatment. She had no associated symptoms including fever, chills, night sweats or weight loss. On physical examination, she was tachypneic and had diminished left lung breath sounds. Laboratory work-up revealed a normal white blood count without bandemia. Chest X-Ray was consistent with complete left lung opacification. The patient was intubated due to worsening hypoxemia. Computed Tomography (CT) of Chest revealed extensive obstruction of the left main stem bronchus with concern for endobronchial lesions. She underwent an emergent bronchoscopy; revealing complete obstruction of the left main stem bronchus; mass like dense granulation tissue was noted with intense airway reaction. A biopsy forceps was used initially to remove the granulation tissue. Subsequently, Argon plasma coagulation was used for mechanical debridement, debulking and restoration of the airway. Histopathology of the evacuated specimen revealed fragments of crystalline and calcified material with intense inflammatory changes. Further history revealed that patient had been taking Calcium acetate pills orally and asking her caregiver to "throw the pill” into her mouth. Her presentation was then explained by a medication aspiration event, and subsequent intense foreign body reaction. The patient was extubated after the procedure, improved clinically and was discharged. DISCUSSION: The clinical presentation of airway obstruction due to medications varies, from dyspnea and focal wheezing to severe inflammation, fibrosis and respiratory failure. The exact response depends upon the properties of the pill ingested. Calcium acetate is known to cause granulation tissue formation following aspiration. A diagnosis may be established by endobronchial surveillance with bronchoscopy along with biopsy or bronchoalveolar lavage. This may also identify the extent of injury and guide interventions to maintain airway patency. CONCLUSIONS: The presence of a focal wheeze, recurrent or non-resolving pneumonia or a new endobronchial lesion in an elderly patient should prompt an early detailed bronchoscopic evaluation. Fatal complications from aspiration can be avoided and treated if recognized in a timely manner. Reference #1: Kupeli, E., et al. (2015). ""Pills” and the air passages: a continuum.” Chest 147(1): 242-250 Reference #2: Kinsey, C. M., et al. (2013). "Evaluation and management of pill aspiration: case discussion and review of the literature.” Chest 143(6): 1791-1795 Reference #3: Mehta AC, Khemasuwan D. A foreign body of a different kind: Pill aspiration. Annals of Thoracic Medicine. 2014;9(1):1-2. https://doi.org/10.4103/1817-1737.124404 DISCLOSURES: no disclosure on file for Toler Doug; No relevant relationships by Mohsin Ijaz, source=Web Response No relevant relationships by Amir Khan, source=Web Response No relevant relationships by Kamran Manzoor, source=Web Response No relevant relationships by DOUGLAS TOLER, source=Web Response No relevant relationships by Fatima Zeba, source=Web Response

Pill in the left bronchus-pediatric foreign body aspiration: a case report

<p>Pediatric population is more prone for accidents such as foreign body aspiration. It is an important and preventable cause of mortality and morbidity in children<strong>.</strong> Pill aspiration is one of the rare causes foreign body aspiration in both children and adults. History is crucial and can guide treatment in case of foreign body aspiration. We present a 5 year old child who had history and examination suggestive of pneumonia which turned out to be a foreign body in left bronchus on computed tomography. The foreign body was a half broken tablet of Co-trimoxazole removed by rigid bronchoscopy without any complication. The child’s symptoms improved satisfactorily following removal. </p>

Airway Obstruction Caused by Iron Pill Aspiration: An Interventional Pulmonology Approach to Prevent Surgery

Iron Pill Aspiration (IPA) is a challenging medical condition that requires prompt management to prevent detrimental outcomes. One of the most serious complications of IPA is airway inflammation which commonly leads to severe obstruction. Airway complications may require surgical intervention including the resection of the affected lung. Prompt recognition and management of IPA can reduce the risk of airway complications and may prevent the need of a surgical intervention. Bronchoscopic management entails the use of flexible and rigid bronchoscopes along with balloon bronchoplasty, ablation of the inflammatory tissue causing obstruction and airway stenting. In this report, we describe a case of severe airway obstruction secondary to iron pill aspiration with favourable outcome following bronchoscopic multimodalities intervention including temporary airway stenting.

A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration.

Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury.

A foreign body of a different kind: Pill aspiration

A foreign body of a different kind: Pill aspiration

Evaluation and Management of Pill Aspiration: Case Discussion and Review of the Literature

Pill aspiration represents a unique type of foreign body aspiration requiring a distinct diagnostic and therapeutic approach. In many cases, the "foreign body" itself may no longer be present, whereas the airway manifestations may persist for months to years. Limited data exist to guide management decisions. We report two cases of severe airway injury secondary to pill aspiration and provide a review of the literature. Endobronchial surveillance may be important to identify impending airway obstruction via secretions, edema, granulation tissue, or fibrotic stricture. In many cases, the airway sequelae of pill aspiration can be effectively managed with bronchoscopy.

Bronchial Stenosis After Iron Pill Aspiration

Bronchial Stenosis After Iron Pill Aspiration

Bronchial Stenosis Due to Potassium Pill Aspiration

Bronchial Stenosis Due to Potassium Pill Aspiration

Sats in the 60s

A 61-year-old man presented to the emergency department (ED) with sudden onset shortness of breath, coughing paroxysms, and a brief loss of consciousness. The emergency medical services (EMS) noted the patient to be diaphoretic and unresponsive, with a prior history of single lung transplantation. His current medications were multiple, without known allergy. Upon ED arrival, the patient was alert and oriented with normal vital signs, except for a marked tachypnea and saturations of 64% on 100% oxygen via a non-rebreather face mask. The initial chest radiograph shows a density in the left upper lung field, missed on the radiologist’s reading of the film (Fig. ​(Fig.1a,1a, arrow). Shortly thereafter, the patient began to cough violently and expelled a large pellet of chalk-like material, ascertained to be the remnants of a calcium supplement. Post expulsion, the oxygen saturation immediately rose to 99% and his respiratory rate decreased to 14. A repeat chest radiograph revealed an absence of the calcified density in the left upper lobe, and clear reduction of adjacent parenchymal atelectasis (Fig. ​(Fig.1b).1b). Clinicians should consider the possibility of pill aspiration on the differential for sudden marked hypoxia and tachypnea, especially in post lung transplant patients. Fig. 1 a Initial and b repeat chest radiographs

Iron Pill Aspiration and Bronchial Stenosis

CASE REPORT A 69-year-old woman with hypothyroidism, hypertension, multiple previous strokes, and partial gastrectomy had been taking daily ferrous sulfate tablets. She remembered aspirating an iron pill when she experienced choking, wheezing, and cough. Chest radiograph was normal. Two months later she was hospitalized with pneumonia and required assisted ventilation. Bronchoscopy at that time revealed extensive inflammation of the truncus intermedius (TI) and left lower lobe bronchus (LLLB). No foreign body was detected but the TI was lined with greenish brown necrotic material (Fig. 1).FIGURE 1.: Extensive inflammation of the truncus intermedius, which was lined with greenish brown necrotic material.Since she remained symptomatic, repeat bronchoscopy was performed 3 months later, revealing 90% and 70% stenosis of the TI and LLLB respectively. Near-total patency of the bronchi was established by balloon bronchoplasty followed by an endobronchial injection of submucosal DepoMedrol. Stenoses of the affected bronchi recurred. Endobronchial biopsies of the TI a year after the episode of aspiration revealed ferric iron in the subepithelial connective tissue with foci of granulation tissue and fibrosis, confirming the patient's history of iron pill aspiration. With informed consent, she underwent a second balloon bronchoplasty followed by topical application of 0.2 mg mitomycin-c via flexible bronchoscopy. Six weeks following the procedure, good patency of the TI and LLLB was demonstrated on bronchoscopy. DISCUSSION Tracheobronchial stenosis, as a result of granulomatous diseases 1,2 and mechanical causes such as prolonged endotracheal intubation or cuffed tube tracheostomy, 3 has been well documented in the literature. Bronchial stenosis due to iron pill aspiration has been observed only in a few reported cases. 4–6 It is often irreversible and may necessitate lobectomy in severe cases. Unlike most foreign bodies, which remain intact in the tracheobronchial tree, the iron pill disintegrates in the airway and cannot be detected via bronchoscopy. However, bronchial biopsy and lung tissue may reveal iron deposits with airway inflammation months after the episode of aspiration. 7 In our patient, diagnosis of iron pill aspiration was established by positive endobronchial biopsies for iron staining with endobronchial findings of intense airway inflammation and stenosis even in the absence of the actual foreign body. 6

Syndrome of Iron Pill Aspiration

Bronchial stenosis (BS) consequent to iron pill aspiration (IPA) has been observed in few reported cases. This condition is often irreversible and may necessitate lobectomy in severe cases. Unlike most foreign bodies (FBs), the iron pill disintegrates in the airway and cannot be detected on bronchoscopy. However, bronchial biopsy and lung tissue may reveal iron deposits along with airway inflammation months after the aspiration. Thus, IPA can be diagnosed by a triad of aspiration, airway inflammation, and iron deposits on histology even in the absence of an FB. We report a case of IPA with BS in which the diagnosis was established by bronchial biopsy and was successfully managed with balloon bronchoplasty and therapy with topical mitomycin C.