CRA3 A TACK IN THE TRACK

Jason Tan Seng Hong1, Benedict Dharmaraj2, Syazatul Syakirin Sirol Aflah3
1Department of Medicine, Hospital Kuala Lumpur, Malaysia
2Department of Surgery, Hospital Kuala Lumpur, Malaysia
3Institute of Respiratory Medicine, Kuala Lumpur, Malaysia

Foreign bodies aspiration (FBA) is mainly found in children but also occur in adults. We described a discovery of foreign body (FB) in an asthmatic patient with optimized treatment presented with poorly controlled bronchial asthma with frequent hospitalization due to recurrent exacerbations.

A 47-year-old woman, with a history of well-controlled bronchial asthma that had become poorly controlled in recent years, presented with an acute exacerbation episode. A chest X-ray revealed hyperinflated lung fields and a foreign body (FB) in situ. The patient later disclosed that she had accidentally inhaled her nose ring two years earlier but had never sought medical treatment. A computed tomography (CT) scan of the thorax showed a well-defined dense FB (0.9 cm) in the right middle lobe bronchus, along with segmental atelectasis. Bronchoscopy revealed a narrowed opening in the right middle lobe with edematous mucosa, but the FB could not be visualized. She was referred to the thoracic team and subsequently underwent a right thoracotomy with segmentectomy, middle lobe bronchotomy, and bronchoplasty, which successfully removed the FB. Postoperatively, she developed ventilator-associated pneumonia and right lower lobe collapse. Despite these complications, she was eventually discharged well.

In general, FBA can occur in adults with variable presentations and should be considered as an alternative cause in certain respiratory cases such as difficult to control asthma and bronchiectasis. This case shown the importance of considering FBA as a differential diagnosis when asthma remains difficult to control despite adequate treatment. Bronchoscopy is crucial for identifying and removing the foreign body, with surgical approach to be considered if bronchoscopy fails.