This case study describes a 31-year-old woman who presented with chronic cough and recurrent pneumonia. Imaging revealed a foreign body obstructing her right lower lobe bronchus, which was encased in bulky granulation tissue. The foreign body, a chicken wishbone fragment measuring 2.5 cm, was removed with forceps during bronchoscopy. Corticosteroids were given before and after removal to reduce inflammation and granulation tissue, facilitating removal of the object and improving the patient's symptoms. She had complete resolution of symptoms after treatment.

1. The Role Of Corticosteroids In The Perioperative Management Of Endobronchial
Obstruction Due To Foreign Body Aspiration
Bassel Ericsoussi, M.D., Dean E. Schraufnagel, M.D., Ruxana T. Sadikot, M.B.B.S.
Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Medical Center at Chicago, Chicago, IL, USA.
Introduction
The role of corticosteroids in the perioperative
management of foreign body (FB) aspiration is not well
established. We report the case of a patient who presented
with chronic cough, localized bronchiectasis and recurrent
pneumonia found to be secondary to foreign body-induced
granulation tissue resulting in endobronchial occlusion. CT scan of the chest shows a soft tissue and calcific density Foreign body almost completely encased in a bulky granulation The foreign body was the head of a chicken wishbone that was
measuring approximately 1.6 x 0.7 cm within the proximal right and obstructing the right lower lobe bronchus. broken off at the head and measured about 2.5 cm at its greatest
Patient improved dramatically with prednisone after
lower lobe bronchus. diameter.
removal of FB.
Case Presentation Foreign Body Removal Role of Corticosteroids
A 31-year-old woman presented with chronic An alligator forceps used to remove the FB (head of a • FBs, particularly those with high oil content may cause
intermittent productive cough of greenish sputum. She was chicken wishbone measuring about 2.5 cm in greatest severe mucosal inflammation with formation of bulky
diagnosed with “asthma” 5 years ago and noted to have diameter). granulation tissue.
recurrent pneumonia since. Her sputum cultures repeatedly • When a FB is completely encased in bulky and bleeding
grew Pseudomonas Aeruginosa. She required several granulation tissue, extraction can be very difficult or
courses of antibiotics and steroids over the last couple of impossible.
years for her poorly controlled asthma. Patient did not • A short course of corticosteroids may reduce the
recall a history of aspiration or choking. Physical inflammatory process and enhance recovery pre or post
examination was notable for occasional low-pitched, CT scan of the chest shows mild localized bronchiectasis in the right extraction and in some cases may facilitate removal of the
monophonic expiratory wheeze heard best over her right lower lobe distal to the Endobronchial occlusion. FB.
lower chest.
Imaging Fiberoptic Bronchoscopy References
The Endobronchial granulation after the removal of the foreign
CT scan of the chest revealed a soft tissue and calcific A diagnostic fiberoptic bronchoscopy showed a FB body.
1. Karen, L. 2002. Flexible Bronchoscopic Management of Airway Foreign
Bodies in Children. Chest 121:1695-1700.
density measuring approximately 1.6 x 0.7 cm within the almost completely encased in a bulky granulation and 2. Baharloo, F. 1999. Tracheobronchial Foreign Bodies : Presentation and
proximal right lower lobe bronchus with localized mild obstructing the right lower lobe bronchus. Frank purulent discharge was noted coming out of the Management in Children and Adults. Chest 115:1357-1362.
bronchiectasis in the right lower lobe distal to the right lower lobe bronchus. The granulation tissue resolved 3. Banerjee, A. 1988. Laryngo-Tracheo-Bronchial Foreign Bodies in Children.
The Journal of Laryngology & Otology 102(11):1029-32.
endobronchial occlusion. post treatment of steroids and patient remains completely
asymptomatic with no further episodes of pneumonia or
“asthma” attacks.
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