Abstract Introduction Pill aspiration is an uncommon event in adults, accounting for approximately 7% of all foreign body aspirations. Clinical symptoms and signs are often nonspecific, and chest X-rays may appear normal, making diagnosis challenging. However, pill aspiration can lead to significant airway injury, including mucosal inflammation, ulceration, necrosis, and stenosis, potentially resulting in long-term complications. Maintaining a high index of suspicion and performing early bronchoscopy are crucial to prevent these sequelae. We present a challenging case of severe bronchial inflammation caused by iron pill aspiration in an elderly patient. Case Report A 91-year-old man with a history of multifocal motor neuropathy and chronic inflammatory demyelinating polyneuropathy presented to the emergency department with chest discomfort and shortness of breath. Initial chest X-ray did not reveal significant abnormalities. On further questioning, he reported an episode of coughing and choking after swallowing an iron pill the day prior. Chest CT revealed an 8.8 mm radio-opaque density in the proximal left lower lobe (LLL) bronchus, along with diffuse narrowing of the left main bronchus. His oxygen saturation was 96% on room air, and auscultation revealed wheezing localized to the left lung field. Flexible bronchoscopy demonstrated complete obstruction of the LLL bronchial orifice by an iron pill, with marked mucosal inflammation and evidence of caustic injury surrounding the site. Approximately 80% of the pill was retrieved intact, while the remaining fragments were removed using a zero-tip basket, biopsy forceps, and suction. Adjacent fibrinous tissue was debrided using cryotherapy. A swallow evaluation, including modified barium swallow, showed intermittent shallow penetration with ejection of thin liquids and a cricopharyngeal bar causing mild retention in the proximal esophagus. Although swallowing was not significantly impaired, dietary modifications were recommended, including soft, bite-sized foods and crushed oral medications mixed with puree. The patient was treated with corticosteroids and antibiotics and discharged home in stable condition with appropriate precautions. Discussion and Conclusion Foreign body aspiration in adults can present with subtle or nonspecific respiratory symptoms, and chest radiographs may appear normal in a substantial proportion of cases. A history of aspiration, even if symptoms seem mild, should prompt further investigation with CT imaging or bronchoscopy. Iron pill aspiration, though rare, is particularly destructive due to its caustic effect on bronchial mucosa, leading to inflammation, necrosis, and potential stenosis. Early recognition and prompt bronchoscopic removal with debridement are essential to prevent irreversible airway damage and ensure optimal recovery. This abstract is funded by: None
Podury et al. (Fri,) studied this question.