Tuberc Respir Dis.  2015 Oct;78(4):440-444. 10.4046/trd.2015.78.4.440.

A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration

• Kwak JH
• Koo GW
• Chung SJ
• Park DW
• Kwak HJ
• Moon JY
• Kim SH
• Sohn JW
• Yoon HJ
• Shin DH
• Park SS
• Pyo JY
• Oh YH
• Kim TH

• KMID: 2320724
• DOI: http://doi.org/10.4046/trd.2015.78.4.440

Abstract

Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury.

Keyword

Iron; Pulmonary Atelectasis

MeSH Terms

Biopsy
Bronchi
Bronchoscopy
Constriction, Pathologic
Cough
Exudates and Transudates
Female
Humans
Inflammation
Iron*
Korea
Necrosis
Phenobarbital
Pulmonary Atelectasis
Iron
Phenobarbital

Figure

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  Figure 1 (A) At admission, chest radiograph shows near total atelectasis of the left lung and a large amount of pleural effusion in the left hemithorax. (B) On the fifth hospital day, chest radiograph reveals clear overall lung field with improved atelectasis and decreased effusion.

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  Figure 2 Chest computed tomography images show near total atelectasis of left lung and a dense calcified nodular lesion (arrow) impacted at the left main bronchus.

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  Figure 3 (A-D) Bronchoscopy shows substantial narrowed proximal portion of left main bronchus with irregular mucosal changes and brown, tarry exudative surface. LLL: left lower lobe; LUL: left upper lobe.

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  Figure 4 (A-C) Bronchial mucosal tissue showed marked necrosis and degeneration with diffusely scattered golden-yellow pigments (A, H&E stain, ×200; B, H&E stain, ×400, arrows). The tissue was stained entirely dark blue with Prussian blue (C, ×100).

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