Unusual aspiration of coin in the lower respiratory tract: Two case reports

RATIONALE: Foreign body (FB) aspiration in adults is occasionally encountered. The aspiration and impaction of a coin in the lower respiratory tract is an unusual accident. This report presents 2 rare adult cases of FB aspiration with coin impaction in larynx and trachea, respectively. PATIENT CONCERNS: Two patients presented to the emergency department separately. Both had a similar history of inadvertent ingestion of a 5-jiao coin that was accidentally enveloped in dumplings. The ingestion was immediately followed by violent cough. DIAGNOSIS: The diagnosis of foreign body aspiration was confirmed by chest x-ray. In the first patient, chest computed tomography (CT) confirmed the shape of the coin and it was located in the laryngeal area, facing C5. In the second patient, CT revealed a metal-density FB located in the tracheal carina. INTERVENTIONS: In the first patient, direct laryngoscopy was performed and the 5-Jiao coin was removed in a direction parallel to the vocal cords. In the second patient, rigid bronchoscopy was used to remove the coin. OUTCOMES: The postoperative period was uneventful in both the patients. LESSONS: During FB removal, the coin should be positioned parallel to the vocal cords during its retrieval through the glottis. Due attention must be paid to avoid asphyxia due to positional changes of the coin in the trachea. Early diagnosis and intervention is the key in such cases as delay can cause catastrophic complications.