A Case of Acute Respiratory Failure Caused by the Misswallowed Rice Cake

Abstract

A 65-year-old man with a past history of left lung tuberculosis was transported to the emergency room of our hospital by ambulance with a complaint of severe dyspnea. At breakfast he ate a baked rice cake (Mochi) and misswallowed a piece of it. After a while dyspnea occurred and became progressively severe. Arterial oxygen pressure breathing room air at admission was 34 Torr. Exploration of the larynx and the pharynx failed to find any foreign body. Fiberoptic bronchoscope, performed under mechanical ventilation, revealed a piece of rice cake impacted in the orifice of the right lower bronchus. Soon after the the removal of the rice cake via bronchoscopy, the patient's PaO_2 improved markedly up to 369 Torr. (FiO_2 1.0) Pulmonary scintigraphy one month later showed neither perfusion nor ventilation in the left lung. This was the reason why only right lower bronchial obstruction caused severe respiratory failure in this patient.