Management of a difficult case involving an endobronchial foreign body.

Aspirated foreign bodies represent a significant cause of morbidity and mortality, both from acute obstruction and asphyxiation and from postobstructive pneumonia and lung abscess. Advances in instrumentation, including telescopes and optical forceps, have significantly improved the ability to retrieve items from the bronchi, yet some situations belie the efficacy of current techniques and continue to pose significant challenges. Spherical objects in particular may become impacted into segmental bronchi and bronchioles and can be particularly challenging to remove. This article reviews the case of a bead lodged in a segmental bronchus.

A 3-year-old girl was brought to the emergency room after an episode of severe choking. A foreign body was not suspected by the parents; however, initial chest radiography revealed a suspicious lesion in the proximal, right, mainstem bronchus (figure 1). Operative bronchoscopy revealed a spherical object impacted in a segmental bronchus (figure 2). The object appeared to have a central channel and, on rotation, was noted to be hollow. This allowed for passage of a No. 5 Fogarty catheter through the object's center. The object was further secured by inflating the catheter's balloon, withdrawing the object into the tip of the bronchoscope, and removing it with the scope (figure 3). The child was observed overnight and discharged the following day without sequelae.

[FIGURE 1-3 OMITTED]

Because of the large and ever-increasing variety of impacted foreign bodies encountered, ENT surgeons must have an equal, if not greater, variety of techniques on hand to deal with individual situations. Potentially the most challenging is a smooth, spherical object, which may become impacted in a smooth bronchus and induce local inflammation and swelling. In most cases, simply grasping the object is not feasible; therefore, other means of securing it become necessary. The use of a balloon-equipped catheter allows for passage around or, as in this case, through the object as an alternate means of safe, atraumatic retrieval.