Foreign Body Extraction by Means of Combined Rigid and Flexible Bronchoscopy: A Case Report

A middle-aged man with a 1-year history of fever, wheezing, and cough productive of yellow, blood-tinged sputum had not responded to bronchodilators or antibiotics. An elevated white blood cell count and an upper lobe mass on chest films led to bronchoscopy via a rigid scope. A foreign body was removed. Introduction of a flexible fiberoptic scope through the rigid scope revealed seven additional fragments distal to the one the rigid scope had revealed, and they were removed by a biopsy forceps. The patient had aspirated a chicken bone but not realized it. Foreign body aspiration should be considered in an adult who presents with recurrent pneumonia, atelectasis of the same anatomic segment or lobe, wheezing of recent onset, or hemoptysis. Rigid-scope bronchoscopy misses foreign-body fragments distal to the field of view, and a flexible fiberoptic scope may enable the operator to find important material that otherwise might be missed and could lead to future symptoms. (Respir Care 1988;33:786-789.)