BRONCHOSCOPIC TREATMENT OF EARLY AND LATE PRESENTATION OF IRON PILL ASPIRATION

SESSION TITLE: Case Report Semifinalists 4 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Iron pill aspiration is a rare condition that can lead to bronchial stenosis due to significant chemical injury to the airway leading to inflammation, scaring, and iron deposition. Here we present two cases of iron pill aspiration that demonstrate difference between acute versus chronic iron pill aspiration and the subsequent treatment strategy. CASE PRESENTATION: Case 1: A 62-year-old female presented after acutely aspirated an iron pill while riding in car. CT scan showed a 10mm foreign body in right lower lobe bronchus. She was hypertensive, saturating well on room air with no respiratory distress. At bronchoscopy, it was noted metallic, disintegrated iron pill was found in the bronchus intermedius and in the right lower lobe. Cryoprobe, 12mm endobronchial basket, and forceps were used to completely remove the metallic material from the airway wall. After inspection of the airway, methylprednisolone (Depo-Medrol) injection and topical Mitomycin C was applied. Repeat bronchoscopy was done 6 weeks after which showed granulation tissue with minimal airway narrowing. Case 2: A 69-year-old female presented with chronic cough. One month prior, she had a CT scan showing right lower lobe occlusion. Initial bronchoscopy noted inflamed, discolored mucosa throughout the right lower lobe. Biopsy is indicative of prior pill aspiration. In addition to airway clearance, Solumedrol and Topical Mitomycin C were applied. Patient underwent additional bronchoscopies which revealed bronchial stenosis refractory to balloon dilation and tissue ablation using electrocautery and cryotherapy. Bonastent was placed and was noted to be in good position. The stent was removed 6 weeks after initial placement, her airways remained patent. DISCUSSION: Iron pill aspiration results in chemical injury to the airway, which leads to scarring in the form of airway stenosis. Delayed presentation results in greater airway scarring due to prolonged chemical injury. Bronchial stenosis can be successfully treated with serial dilation, local application of solumedrol/mitomycin c, and short period of airway stenting. CONCLUSIONS: Early bronchoscopic evaluation of suspected iron pill aspiration can lead to prompt interventions that obviate the need for airway stenting. Reference #1: Lee P, Culver DA, Farver C, Mehta AC. Syndrome of iron pill aspiration. Chest. 2002 Apr;121(4):1355-7. Reference #2: Mehta AC, Khemasuwan D. A foreign body of a different kind: Pill aspiration. Ann Thorac Med. 2014 Jan;9(1):1-2. Reference #3: Jimenez Rodriguez BM, de Jesús SC, Merinas López CM, Gónzalez de Vega San Román JM, Romero Ortiz AD. Bronchial stenosis after iron pill aspiration. J Bronchology Interv Pulmonol. 2013 Jan;20(1):96-7. DISCLOSURES: Owner/Founder relationship with Restore3D Please note: $5001 - $20000 Added 11/27/2018 by George Cheng, source=Web Response, value=Ownership interest Consultant relationship with Medtronic Please note: $1-$1000 Added 11/27/2018 by George Cheng, source=Web Response, value=Consulting fee Research relationship with Intuitive Surgical Please note: $20001 - $100000 Added 11/27/2018 by George Cheng, source=Web Response, value=Grant/Research Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 11/27/2018 by George Cheng, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Pinnacle Biologics Please note: $1-$1000 Added 11/27/2018 by George Cheng, source=Web Response, value=Honoraria Research relationship with Veran Please note: $1001 - $5000 Added 11/27/2018 by George Cheng, source=Web Response, value=Grant/Research Support no disclosure on file for Wendy Curry; No relevant relationships by Coral Giovacchini, source=Web Response No relevant relationships by Hope Johnson, source=Web Response No relevant relationships by Kamran Mahmood, source=Web Response no disclosure on file for Deepika Malhotra; No relevant relationships by Luke Seaburg, source=Web Response no disclosure on file for Scott Shofer; No relevant relationships by Momen Wahidi, source=Web Response