Removal of a Large Endobronchial Foreign Body with a Fiberoptic Bronchoscope

Miquel Ferrer, MD, Servei de Pneumología, Hospital Clínic, Villarroel 170, E-08036 Barcelona (Spain) To the Editor The aspiration of foreign bodies into the tracheo-bronchial tree is frequent in childhood, but it is also not unusual in adults as a labor accident (nails, pins), in mentally retarded patients, in prison population and as suicidal attempts. Although large endobronchial foreign bodies usually require the use of a rigid bronchoscope (RB) [1, 2], we have recently removed a big nail clipper using a fiberoptic bronchoscope (FB). A 26-year-old imprisoned male intravenous drug abuser, came to the emergency room of our hospital because of cough and dyspnea. The physical examination was normal and a chest x-ray film showed a nail clipper behind the right pulmonary hilus which was outside the esophagus and measured 6.5 × 1.7 × 1.8 cm (fig. 1). Fiberoptic bronchoscopy (Olympus BF-10) showed the nail clipper to be located in the right main bronchus. We inserted a grasping forceps (Olympus FG-4L) through the channel of the FB and successfully took out the foreign body together with the FB. During the last 15 years, the FB has been progressively introduced into clinical practice, while the use of the rigid bronchoscope (RB) has decreased for several reasons: worse clinical tolerance, the need of sedation, technical difficulty and worse vision of distal airways. However, the removal of foreign bodies (especially the larger ones located in the proximal airways) remains a first-choice indication of RB [1, 2], since it allows the introduction of larger and stronger forceps, ventilation of the anesthesized patient if required, and is successful in most cases when FB has Fig. 1. a Chest X-ray film. The nail clipper is located behind the right pulmonary hilus. b Esophagogram. The foreign body is outside the esophagus. 232 Ferrer/Ferrer/Marín