Abstract

NM-323

Thumbtack Embedded in Bronchus

Sangari T, Sims R, Mustafa M, Martin T
University of Florida, Gainesville, Florida, United states

Introduction: We present a case report of a novel way to retrieve a chronically embedded foreign body in tracheobronchial tree. 
Case Report: 14-year-old, 94Kg male with medical history of developmental delay presented with worsening cough and shortness of breath. On further questioning patient admitted accidental aspiration of a staple pin. CT scan illustrated a 13mm long foreign body (FB) within the right main bronchus with its tip extending into the right upper lobe bronchus. Patient was scheduled for FB removal via bronchoscopy under general anesthesia. A 7.5mm endotracheal tube was placed following intravenous induction with propofol and fentanyl. While maintaining spontaneous respiration with propofol infusion, a 4.2mm flexible bronchoscope was inserted via endotracheal tube. Visualization of right main bronchus revealed granulation tissue covering FB. While gently removing mucus, FB was identified as a thumbtack. Forceps were inserted through scope channel to retrieve the FB but it was immobile. We realized that the blunt end of the thumbtack was plugging the right upper lobe airway while the pin was penetrating the right main stem bronchus. It became evident that the FB had been embedded in bronchus for some time and this was not an acute aspiration. Any application of force to pull out FB could lead to bronchial injury. Decision was made to grasp the plastic end of thumbtack with forceps and push FB distally towards the right upper lobe. This maneuver successfully dislodged the sharp end from the bronchus and the blunt end of thumbtack slid in the right upper lobe. With forceps, the needle end of the tack was seized and thumbtack was successfully removed with endotracheal tube. Chest x-ray was performed to rule out pneumomediastinum or pneumothorax. 
Discussion: Removing a thumbtack from airway can be a challenge if they have been embedded for some time. Misaligned traction on tack can lead to airway injury. We describe an effective way to remove an embedded thumbtack by pulling it away in direction of needle insertion. 
Reference: 
Thornton CS et al. Rigid bronchoscopy and balloon dilation for removal of aspirated thumbtacks: case series and literature review. Int J Pedia Oto 2015;79:1541-3