Distal Airway Aspirated Metallic Foreign Body, Case Report of Spontaneous Expectoration

Patient: Male, 7-year-old Final Diagnosis: Foreign body aspiration Symptoms: Choking Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Foreign body aspiration is one of the life-threatening conditions seen in the adult and pediatric population with most cases occurring within the first 3 years of life. It can result in serious complications or even lead to death. Bronchoscopic removal has been described as the management of choice. Spontaneous expectoration could happen, though it is extremely rare. CASE REPORT: A 7-year-old male presented to the Emergency Department within 3 hours of aspirating a metallic nail. He had a brief choking episode at the beginning and remained asymptomatic thereafter. The initial chest x-ray showed a metallic foreign body (nail) at the retrocardiac area with patent centralized tracheobronchial tree. No radiologic signs of pneumothorax nor pleural or pericardial effusion. Computed tomography (CT) scan was performed the night of admission and revealed a 2 cm nail at the posterior basal segment of the left lower lobe bronchus. Bronchoscopy, thoracoscopic-removal, and possible thoracotomy were discussed. Management options and complications were explained. The parents preferred to wait and observe before making any decision regarding surgical intervention. Surprisingly, while in the hospital, the patient had repetitive cough and the nail was spontaneously expectorated. CONCLUSIONS: Urgent bronchoscopy for foreign body aspiration is mandatory as early as possible, however, expectant management in asymptomatic distal airway foreign body aspiration is reasonable. Spontaneous expectoration is a possible outcome though extremely rare.