A Case of the 47-year Presence of a Bronchial Foreign Body Presented with Acute Pleural Empyema and Removed by Flexible Bronchoscopy

Abstract

A 56-year-old man was referred to our hospital due to left acute pleural empyema. Computed tomography scans revealed left massive pleural effusion and atelectasis of the left lower lobe with obstruction of the left lower bronchus and circular calcification of the bronchial wall. Bronchoscopy revealed obstruction of the ostium of the left lower bronchus by granulomatous tissue. Histopathological examination did not identify any malignancy or significant bacillus. His acute pleural empyema improved following reduction in inflammation indices after video-assisted thoracoscopic pleural decortication. Follow-up bronchoscopy detected decreasing granulation tissue of the bronchial mucosa and a cylindrical foreign body in the left lower bronchus. The patient underwent tracheal intubation with deep sedation for extraction of the foreign body by bronchoscopy. Single forceps via an operation channel of the bronchoscope failed to extract the foreign body. Additional forceps were inserted alongside the bronchoscope so opposite sides of the foreign body could be grasped simultaneously and gently extracted without damaging the surrounding tissue. The foreign body was a plastic pencil cap the patient had aspirated accidentally when playing in a swimming pool at nine years of age. We safely and successfully removed the 47-year lasting bronchial foreign body using flexible bronchoscopy.