All that glitters is not gold: A case of lanthanum carbonate aspiration

INTRODUCTION: Foreign body aspiration is a significant cause of morbidity and mortality in elderly hospitalized patients. These are typically small items that patients have access to, including small coins. CASE PRESENTATION: This is a case report of a 75-year-old man recently bedridden from a large hemispheric stroke with sudden onset of hoarseness, cough and dysphagia. A chest X-ray was obtained which showed a radiopaque coin-shaped foreign body, presumably a coin in his aerodigestive tract. He was promptly taken to the endoscopy suite for upper endoscopy. During endoscopy, it was determined that the foreign body was a radiopaque medication that he had been given. It was easily and safely able to be crushed and lavaged down into his stomach and later determined to be lanthanum carbonate, a commonly used phosphate binder. Following endoscopy, the patient’s cough, hoarseness and dysphagia resolved with no long-term complications. DISCUSSION: Lanthanum carbonate is a phosphate-binding medication used in the management and treatment of hyperphosphatemia commonly seen in patients with end-stage renal disease, which is radiopaque. There are few published reports and images of radiopaque fragments of medication in the gastrointestinal tract but none causing aspiration by masquerading as a coin-like density in the aerodigestive tract as we present here.