A 67-Year-Old Man With Chest Pain and Wheezing

Carla R. Sterling, MD; Niccole Bart, MD

Disclosures

July 15, 2015

Definitive treatment is removal of the foreign body, which requires consultation by an ear, nose, and throat specialist or pulmonologist. Specialist referral is essential unless the foreign body is easily visible and graspable.[7]

In addition, studies have shown that flexible bronchoscopy may be a less desirable approach because both the scope and object are removed together within a narrow suction canal; if the object is dropped during retraction, the airway may be at risk for complete obstruction. This research concluded that if flexible bronchoscopy is the first attempt, rigid bronchoscopy along with preparation for emergent tracheostomy should be available in the room during the procedure.[5] In a specific subset of patients who aspirate soft or thickening food, such as those who have had stroke, airway protection may require intubation, because the texture of the food makes it difficult to remove.

Caustic aspirations are significantly less frequent than caustic ingestions or foreign body aspirations, but these events can be fatal if not recognized and treated appropriately. Huang and colleagues[8] describe an alkali aspiration within the respiratory organs, causing chemical tracheobronchitis and corrosive necrosis of the lung parenchyma. These physiologic processes can result in rapid formation of tension pneumothorax and hemothorax, which ultimately requires surgical intervention of thoracotomy with lobectomy. Airway management is crucial; Huang and colleagues describe a specific technique involving bronchoscopic intubation with a large endotracheal tube and daily fiberoptic bronchoscopy to remove debris and clear the airway.[8] Airway fibrosis and mucociliary dysfunction are noted as the main complications after caustic injury. Cases have been reported of airway involvement in gastrointestinal ingestions of caustic agents involving both main bronchi.[9] The bottom line is early and aggressive airway management.

Aspiration of button batteries is cause for similar concerns to those of button battery ingestion. Metals immersed in potassium hydroxide can leak and cause liquefactive necrosis. The button battery itself can cause pressure necrosis and result in electrical injury if the positive and negative electrodes interact.

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