Review of Respiratory Medicine - Volumen 25, Número 1 - March 2025

Imaging In Pulmonology

Unusual Foreign Body in the Airway

Cuerpo extraño en vía aérea

80-year-old male patient with a history of atrial fibrillation under oral anticoagulation treatment. The patient presents with odynophagia, which began after he “hastily” took his regular medica­tion. On physical examination he was eupneic at rest, with good bilateral air entry and 96% oxygen saturation on room air. The examination conducted by an otorhinolaryngologist showed the presence of a foreign body between the vocal cords. A thoracic CT scan of neck and chest (Figure 1) revealed a linear, metallic-appearing object in the larynx. With the patient under sedation, a laryngeal mask was placed and flexible bronchoscopy was performed, revealing a medication blister pack with a tablet inside (See video/supplementary material). With a biopsy forceps, the object was successfully removed. The foreign body was identified as a tablet of apixa­ban in its original packaging (Figure 2).

The edges of the blister pack only caused minimal mucosal lacerations. The patient was told to restart anti­coagulation 48 hours after the bronchoscopy, and a videofluoroscopic swallow study was suggested. He was discharged 12 hours after the procedure without complications.

A bronchoscopy is commonly performed for the removal of foreign bodies in the airway. Both the flexible and rigid bronchoscopies are useful, and the choice between them will depend on the characteristics and location of the foreign body, the patient’s clinical conditions, and the exper­tise of the operator. It is generally performed via endotracheal intubation, but in this case we had to use a laryngeal mask because the foreign body was located between the vocal cords and into the subglottic space. This case is interesting due to the atypically mild symptoms described before and the unusual characteristics of the foreign body.

https://drive.google.com/file/d/14S8NaiGyz2mhL1WgXSWGwD8aSum1qBIH/view?usp=sharing

Conflict of interest

The authors have no conflict of interest to declare.

REFERENCES

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2. Rafanan AL, Mehta AC. Adult airway foreign body removal. What’s new? Clin Chest Med 2001;22:319-30. https://doi.org/10.1016/S0272-5231(05)70046-0