Foreign Body Aspiration: An Unusual Presentation and Outcome

A 60-year-old male who was being worked up for surgical management of cholelithiasis was advised medical consultation for his respiratory complaints.He was a chronic smoker and had a history of long standing cough with dyspnoea on exertion with periodic exacerbations.There was a definitive change in pattern of cough for the last 3 months and he was expectorating mucopurulent sputum.He however ignored it as a seasonal event, that was not very unusual for him.There was no history of fever, haemoptysis, chest pain or increased shortness of breath from baseline.Routine investigations including haemogram, electrocardiogram, liver function test, renal function test, serum electrolytes, fasting blood sugar, coagulogram and urine complete examination were normal.Sputum was negative for acid fast bacillus.Chest radiograph showed paracardiac opacity in right lower zone [Table /Fig -1].Computed Tomography (CT) of chest showed collapse consolidation of right lower lobe of lung [Table / Fig -2].Keeping in view prolonged smoking history, age, change in character of cough as reported by the patient, paracardiac opacity and CT findings, malignancy was suspected and patient was taken up for bronchoscopy and during the procedure a suspected mass was seen in the right main bronchus [Table /Fig- 3], it was cauliflower like, whitish yellow in colour causing almost complete occlusion of the right main bronchus.Multiple endobronchial biopsies were taken using an alligator jaws type biopsy forceps.As the third biopsy was being taken the mass came up along with the biopsy forceps.At this point it was realised that probably it was a foreign body.An attempt was made to take it out by pulling out the bronchoscope along with the foreign body attached to the biopsy forceps.But during the process, the patient coughed violently and got very restless.As the bronchoscope was taken out, it was observed that the foreign body had got dislodged.The patient suddenly became dyspnoeic and his oxygen saturation began to fall to around 70%.He was given high flow oxygen by a mask and bronchoscope was reintroduced once saturation improved to around 90%.Now the foreign body was seen lying in the left main bronchus.Patient's head end was lowered and attempt was made to take out the foreign body with a grasping forceps.After a few failed attempts, it was possible to hold it with the grasping forceps.However, again as bronchoscope was negotiating the vocal cords, the patient coughed violently and got up pulling out the bronchoscope.It was noticed that the foreign body