Paras HMRI Hospital successfully done bronchoscopy to rule out foreign body aspiration in a 56 year old woman. Bronchoscopy revealed pea nut in right lower lobe bronchus just above the basal segments which was removed by Dr Saket Sharma.
The woman was a known patient of post TB sequale with left sided destroyed lung with COPD, developed sudden onset breathlessness following an episode of aspiration while having her evening breakfast. Her condition worsened rapidly and she was referred to Paras HMRI Hospital for further management. In view of excessive respiratory distress, she was admitted in ICU. She electively incubated and put of mechanical ventilation. Bronchoscopy was done to rule out foreign body aspiration.
Foreign body was dislodged using dormia basket from basal segment and subsequently pulled in to endotracheal tube, which was removed in toto and reintubation was done. Repeat Bronchoscopic evaluation of bronchial tree was done to rule out any remaining fragment.
Bronchoscopic removal of organic foreign body is tricky business. Once aspirated, they cause obstruction of airway; they rapidly swell up cusing further obstruction and intense inflammation of bronchial tree. Granuloma formation takes place rapidly, making indentification difficult. bronchoscopist doing removal has to make sure, that he does not fragment, does not push it further into bronchial tree, making situation worse. She already had a compromised lung because of tuberculosis in past, which had destroyed left lung completely. She was living on one healthy lung. Now, unfortunately, she had aspirated a pea nut in healthy lung. She lands up in life threatening respiratory failure. Her only chance of survival was removing the foreign body as early as possible.
Dr Saket Sharma (bronchoscopist, pulmonary & critical care expert) along with Dr Kishore and his intensive care team were able to accomplish the task in most desirable way.