C44-28 Lung Packer: Cocaine Packet Aspiration

Abstract Introduction Foreign body aspiration (FBA) in adults is uncommon and usually involves food particles, teeth, or dentures. Aspirating illicit drug packets is exceedingly rare. Unlike organic foreign bodies, a sealed drug packet can rupture during removal, causing acute systemic toxicity. We present a case of cocaine packet aspiration, highlighting the need for high clinical suspicion and careful management due to the potential for fatal complications. Case Presentation A 51-year-old man with a history of seizures presented with 4 days of dyspnea, fever, and chills. He was tachypneic but maintained 97% O2 saturation on room air. The lung exam revealed crackles and localized wheezing at the right base. Chest radiograph showed a right lower lobe opacity. Aspiration pneumonia was presumed and broad-spectrum antibiotics were started. However, symptoms persisted. Chest CT then revealed a well-defined intrabronchial foreign body in the bronchus intermedius, prompting bronchoscopy. Flexible bronchoscopy identified and removed an intact, sealed cocaine packet from the right bronchus. Urine toxicology was positive for cocaine. On further questioning, the patient admitted to choking on a cocaine packet four days prior while drinking soda. He had been attempting to transport the drugs (“body packing”) when he accidentally aspirated the packet. The patient’s respiratory status improved rapidly after removal, and a follow-up chest X-ray was normal. Discussion Illicit drug packet aspiration is a rare and often unrecognized cause of airway obstruction. Unlike typical adult foreign body aspirations, which usually involve food or teeth, drug packets appear on imaging as smooth, ovoid, or rectangular objects. In this case, CT imaging was crucial for identifying the obstruction and guiding intervention. Because patients may provide misleading or no history, clinicians must maintain a high index of suspicion when imaging shows an unusual endobronchial object. Bronchoscopic removal carries substantial risk, as packet rupture can release toxic cocaine, causing seizures, arrhythmias, pneumonia or cardiovascular collapse. Timely, careful retrieval with minimal manipulation is essential to prevent potentially fatal complications. Clinical implications Foreign-body aspiration in body packers is a rare but potentially life-threatening event. Early recognition, prompt imaging, and coordinated intervention are critical to preventing severe complications. This case underscores the importance of preparedness, meticulous procedural planning, and awareness of the specific risks associated with airway drug packets. This abstract is funded by: None