A 91-year-old woman who was admitted to our hospital for dyspnea presented with bilateral wheezing despite normal chest radiograph findings. Although she was treated for bronchial asthma, her respiratory condition worsened. Chest computed tomography revealed stenosis of the left main bronchus and an area of high attenuation in the bronchial wall (Picture). Bronchoscopy revealed the nearly total obstruction of the left main bronchus by a pill-like object, which was positively stained for iron (Picture). Furthermore, the endobronchial mucosa was hemorrhagic and was yellowish-brown in color (Picture). Detailed history taking revealed that she had the habit of taking iron tablets.
Picture.
One month later, bronchoscopy revealed necrosis of the bronchial cartilage (Picture) and expiratory bronchial collapse.
In the present case, the symptoms of the iron pill aspiration were non-specific. A delay in diagnosis and removal may lead to severe mucosal inflammation, necrosis, and bronchial stenosis (1). However, high-density lesions with a metal-like appearance on computed tomography may serve as a clue when making the diagnosis (2).
The authors state that they have no Conflict of Interest (COI).
References
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