Inhaled Foreign Body - trachea - Erler Zimmer

Inhaled Foreign Body - trachea - Erler Zimmer

Clinical History

A 57-year-old male complained of a 3-week history of cough and pleuritic left-sided chest pain. A chest x-ray revealed collapse of the left upper lobe with a large pleural effusion on the left side. Pleurodesis extracted pus from the pleural cavity. Despite pleural drainage and antibiotic treatment, the patient succumbed.

Pathology

This specimen displays the lower trachea and main bronchi, cut open to reveal the sliced left upper lobe's surface. An impacted foreign body, an inhaled rabbit vertebra, is lodged at the origin of the left upper lobe bronchus. The obstruction led to upper lobe collapse, pneumonia, and fibrinous exudate covering the pleural surface. This represents inhaled foreign body with associated collapse, pneumonic consolidation of the left upper lobe, and empyema.

Further Information

Inhalation of a foreign body or foreign body aspiration (FBA) occurs when a foreign body is inhaled into the airway, causing partial or complete obstruction. This can be life-threatening and is more common in children than adults, being a leading cause of accidental death worldwide. Highest mortality risk is in those under 1 year old and patients over 75 years old.

Risk factors for FBA in adults include decreased consciousness level, drug or alcohol intoxication, or anesthesia. Additional risk factors in the elderly include medication use impairing cough and swallowing, stroke-related dysphagia, and degenerative neurologic diseases like Alzheimer‘s or Parkinson‘s. In adults, commonly aspirated foreign bodies include inorganic items (e.g. nails, pins, dental debris) and organic material (e.g. bones, improperly chewed meat, watermelon seeds). Symptoms vary based on the degree of airway obstruction. Larger obstructions may present as choking or sudden asphyxia, while smaller foreign bodies may cause insidious symptoms like cough, dyspnea, fevers, chest pain, and hemoptysis. Airway collapse distal to the foreign body leads to infection. Treatment involves retrieving the foreign body through bronchoscopy or emergency tracheostomy.