A 55 year old man came to our clinic with refractory cough and a nagging sensation of a prick in the middle of the chest for about 10 days. The trouble started after a drink of ‘kharoda soup’ – also called as bone soup or bone broth made by boiling an animal bone in water along with other ingredients. The suspicion of aspiration of a small piece of bone was confirmed on chest radiography. On bronchoscopic examination, at your best chest clinic, the bone was found stuck in the right main bronchus, was removed with some difficulty.
Aspiration of a foreign body is common in children but not an uncommon happening in adults. In adults, it commonly happens during an ebriated state following an alcoholic binge. Other medical conditions may include a stage of altered consciousness or convulsive fit. Children may commonly aspirate nuts, pins, buttons, beads, small coins or other similar objects kept in the mouth during a bout of cough or laughter.
Aspiration may occasionally prove to be a life-threatening emergency in case the aspirated foreign body gets lodged in the larynx or trachea. Lower down in the respiratory tract, it may get lodged in the right main bronchus, carina, the left bronchus, or distal branched of the bronchial tree. It may also cause breathing problem, cough or choking. Wheezing and bleeding may sometimes occur. If the same is not removed in time, the surrounding area gets inflamed and infected.
The diagnosis of a foreign body aspiration is made from history and confirmed by a combination of tests such as x-rays, endoscopy, or sometimes computed tomography (i.e. CT scanning). In a significant number of patients, the clinical history is missing. This is especially so in case of children. Many foreign bodies are coughed out without treatment. But a foreign body which is stuck in the bronchial tree, requires to be removed either bronchoscopically or occasionally on surgery. Bronchoscopy under general anaesthesia is the procedure of choice for diagnosis and management in case of children. Flexible bronchoscopy performed with a fiberoptic instrument is more commonly done by pulmonary physicians especially in adult patients.
We at the Jindal Chest Clinic have had a chance to help patients with fiberoptic bronchoscopy without resorting to the rigid procedure or the surgery. It is however important to keep the possibility in mind and educate the children to avoid keeping small objects in the mouth. Adults need to be cautious while eating food (or even drinking ‘kharoda soup’) along with alcohol.
