The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Janice Ellis, Joel M. Brown, Gerald M. O’Brien; Christiana Care Health System, Newark, DE

Introduction: The incidence of foreign body (FB) aspiration in the adult population is difficult to ascertain, often because they are spontaneously cleared, and therefore not reported. However, patients who are unable to spontaneously clear foreign objects have significant morbidity and mortality. Retrieving a FB in patients can be challenging if granulation has already occurred. Electromagnetic Navigational Bronchoscopy (ENB) has been utilized to locate lung masses in airways previously inaccessible by conventional bronchoscopy. Case Summary: In this case, a woman presented to her primary care physician with a persistent cough, CXR and CT scan revealed a thin metallic object in the LLL. The patient was referred to the Interventional Pulmonologist (IP) who was presented with the challenge of finding and retrieving the object. Upon review, it was decided to utilize the ENB software to identify the exact location of the FB. A special CT scan rendered a 3D image of the airways, allowing the IP to know the exact location of the FB. Knowledge of the FB’s location provided an opportunity to gather the necessary equipment to retrieve the object from the small airways. This plan of action proved to be extremely effective, as the object was located in the anterior segment medially of the LLL. A rigid bronchoscope was utilized for airway control, and a pediatric bronchoscope was necessary to access the small airways. In an eight year review of over 7,000 bronchoscopies performed in this particular facility, removal of a foreign body was the primary reason in 0.53%, and FB retrievals requiring rigid bronchoscopy occurred in 6% of those cases. In FB retrieval cases, a large channel bronchoscope is normally utilized. However, due to the depth of this object; a true “needle in a haystack” scenario, a pediatric bronchoscope was required. Knowing the exact location of the object, by way of the ENB software, allowed the team to locate and retrieve the pin safely and quickly, and the patient to be discharged on the same day. Discussion: The retrieval of a FB that has been aspirated is a challenging prospect, and most often is not an elective procedure. In this case, the patient was not in distress, but the removal of the foreign object was justifiable. Utilizing the ENB software, the team was able to determine the exact location of the object; therefore decreasing the procedure time and having the proper equipment prepared for the smaller airways. Sponsored Research - None The ball pin after it was removed from the patient’s left lower lobe.