Abstract Case Presentation A 58-year-old male presented to Respiratory Clinic with a persistent cough and abnormal CT findings. He has a background history of HIV, Type 2 Diabetes Mellitus on Insulin, Pancreatic insufficiency, Asthma and an ex-smoker of 20 pack-years. In late 2024, he experienced a near choking episode while eating chicken and felt a hard food bolus at the back of his throat. After attempts to dislodge the bolus, he assumed he swallowed a chicken bone. Coincidentally, in the weeks prior, he presented to his general practitioner with a persistent cough and a family history of lung cancer. The GP referred to respiratory and a CT chest was ordered. The CT revealed a Foreign Body (FB), likely a chicken bone, in the right main bronchus, with associated granulation tissue and mucous plugging (figure 1c). Further findings included emphysema and reactive right-sided lymph nodes. He was referred for Rigid Bronchoscopy (RB), however, it was delayed until late January 2025 due to the patients prearranged travel plans. Pre-operatively, concerns were raised regarding the prolonged period the FB was retained in situ, potential bleeding risks due to its proximity to major vessels, and the brittle nature of a cooked bone. The RB was performed under general anaesthesia, topical adrenaline was applied to the affected area, and a 3.1cm (figure 1a) chicken bone was successfully removed with no bleeding. There was significant granulation of the surrounding tissue (figure 1b) and at follow-up RB this resolved. Conclusion In such cases, it is important to consider the location of the FB in relation to other anatomical structures; to plan for bleeding risks; and to understand the changes to endobronchial tissue at delayed presentation. Granulation tissue may have made it difficult to remove the bone from the airways, particularly as it was not known if the bone had jagged edges embedded into surrounding tissue. Knowledge of anatomy was crucial, as proximity to pulmonary vessels could carry risks of large volume bleeding after removal. To manage these risks, pre-treatment with tropical adrenaline was applied; ventilation was suspended on removal of the FB to prevent dislodging it; and follow up of RB was arranged to ensure resolution of granulation tissue. This abstract is funded by: None
Power et al. (Fri,) studied this question.