Abstract Introduction Pill aspiration, a subcategory of foreign body aspiration, occurs with prescribed or over-the-counter medications. These cases can represent diagnostically complicated scenarios as patients often present with nonspecific respiratory symptoms. The extent of injury depends on the composition of substance aspirated as well as timing of recognition and intervention. This case highlights an unusual presentation of a female who aspirated an iron containing multivitamin in the right lower lobe. Case report A 60-year-old female without significant past medical history presented to the emergency department with a one-day history of right sided chest discomfort, dry cough, and dyspnea. The patient was found to be afebrile and tachycardic to 120 beats per minute. Pertinent lab work includes white blood cell count of 18.4x103/uL. Chest X-ray showed a hazy right lower lobe opacity initially interpreted as likely atelectasis. CT angiography of the chest demonstrated 1.3 cm endobronchial lesion with a differential including carcinoid tumor versus obstructing vascular lesion. Empiric antibiotics were initiated for community acquired pneumonia (CAP) and pulmonology was consulted. Bronchoscopy performed on hospital day two identified a granular mass consistent with an aspirated pill and significant amount of purulent material distal to the lesion. The foreign body was removed, and the patient was discharged with antibiotics to complete a 10-day total course. At follow-up two weeks after discharge, repeat bronchoscopy showed granulation tissue without endobronchial nodularity or masses consistent with resolving injury. Discussion Pill aspiration of iron containing medication carries the potential for significant injury to the bronchial tree. In this case, iron in the patient’s multivitamin likely contributed to the mucosal injury and post-obstructive infection. Iron causes inflammation of varying severity to the mucosa but has the potential for more serious complications such as fibrosis and bronchial stenosis. This case underscores the significance of remaining vigilant for pill aspiration when evaluating patients with nonspecific respiratory complaints. Bronchoscopy was successfully performed, and she was discharged with a course of antibiotics for CAP complicated by post-obstructive purulence. This case emphasizes the critical importance of early bronchoscopy to inspect the airway and remove foreign material. Carcinoid tumor was appropriately considered in this case given the location of the lesion on chest imaging at presentation, which was ruled out upon luminal inspection. Repeat surveillance bronchoscopy is frequently required to ensure resolution of mucosal injury and prevent long-term sequela of damage. This abstract is funded by: None
Carver et al. (Fri,) studied this question.