MDCT Imaging of Foreign Body in Adult Bronchus: Case Series of 3 Patients

Background: Foreign body (FB) aspiration refers to the entry and lodgement of a foreign material within the tracheobronchial tree. Foreign body aspiration is more common in children than adults and accounts for 25% of all cases of foreign body aspiration. FB in adults primarily presents with nonspecific chronic or subacute respiratory symptoms, such as cough, dyspnea, hemoptysis, fever, and chest pain, which overlap extensively with other pulmonary diseases. Retained FB’s may lead to recurrent pneumonias, bronchiectasis, recurrent hemoptysis, pneumothorax, lung abscesses, pneumomediastinum, or other complications. Multidetector row Computed Tomography (MDCT) provides information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. The objective is to discuss the clinical presentation, CT imaging characteristics, bronchoscopic findings and treatment outcomes of foreign body impaction in adult bronchus. To highlight the importance of early suspicion and the need for early imaging and bronchoscopy. Material and Methods: The study was conducted at the East Point College of Medical Sciences and Research Centre comprising of three subsequent patients diagnosed with airway foreign body impaction. Patient demographic details, clinical features, examination findings, co-morbidities, smoking status and betel nut chewing habits were obtained. All the three patients were subjected to MDCT. All images were reconstructed at 1mm intervals using a standard reconstruction algorithm into 3D virtual images. Patients were subsequently subjected to Flexible + Rigid Bronchoscopy. The clinical, radiological and bronchoscopic data were analysed. Results: CT diagnosed foreign bodies in 2 patients and 1 case the CT features stimulated endobronchial lesion (malignancy). Lungs showed consolidation with areas of break down distal to the bronchus. In all 3 cases the foreign bodies were seen on right side and were organic. Conclusion: Foreign body impaction in adults remains an uncommon but important clinical entity that is frequently underdiagnosed because of its nonspecific and variable presentations. MDCT along with virtual bronchoscopy can provide information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for both diagnosis and treatment. Early suspicion, timely imaging, and bronchoscopic interventions are crucial to reduce morbidity and prevent long-term pulmonary complications.

Keywords: Foreign body, MDCT, bronchus, bronchoscopy.