Rationale: Foreign body aspiration is most common in toddlers but can occasionally occur in adolescents. Sharp metallic foreign bodies pose a particular challenge for bronchoscopic removal because of the high risk of airway injury and the limitations of standard retrieval instruments. Complex cases may require innovative extraction techniques. Patient concerns: A 12-year-old boy presented with acute respiratory symptoms, including dyspnea, chest tightness, chest pain, cyanosis, and 1 episode of vomiting. No foreign body aspiration was reported at the initial presentation. After repeated and detailed history-taking, it was revealed that the patient had accidentally aspirated a foreign body while attending class. Diagnoses: Low-dose chest computed tomography demonstrated a hyperdense foreign body in the right lower lobe bronchus. Bronchoscopy confirmed a vertically impacted drawing pin, with its plastic head completely occluding the bronchial lumen. Interventions: A modified foreign body retrieval basket technique was applied. The basket was advanced over the sharp tip of the drawing pin and tightened around the mid–upper portion of the shaft, maintaining the tip in the center of the airway. The foreign body was then extracted by simultaneous withdrawal of the flexible bronchoscope and the basket. Outcomes: A drawing pin ~3 cm in length was successfully removed without airway injury. The patient recovered uneventfully, was discharged the next day, and remained asymptomatic during follow-up. Lessons: Vertically impacted metallic airway foreign bodies may be difficult to remove using standard bronchoscopic tools. The modified retrieval basket technique provides a safe and effective option for extracting high-risk metallic foreign bodies while avoiding thoracotomy.
Xu et al. (Fri,) studied this question.