Figure 1
CT scan
Aspirated tooth
SectionChest imaging
Case TypeClinical Cases
AuthorsAlmeida J, Leal C, Figueiredo L
Connected authors
28 years, male
Clinical History
A 28-year-old man, unconscious, was brought to the hospital immediately after a major car accident.
Imaging Findings
A CT-scan was performed, revealing a high-density elongated structure located in the trachea, in a dependent position, measuring 24mm x 6mm.
Patient was re-evaluated a few hours later, revealing migration of the high-density foreign body structure to the right bronchial tree, positioned in the origin of the right lateral basal bronchus.
Based on the context, morphology and density of the foreign body, it was assumed it was a tooth.
Patient underwent rigid bronchoscopy, with removal of the foreign body and confirmation of the suspected nature - an aspirated tooth.
Patient was re-evaluated a few hours later, revealing migration of the high-density foreign body structure to the right bronchial tree, positioned in the origin of the right lateral basal bronchus.
Based on the context, morphology and density of the foreign body, it was assumed it was a tooth.
Patient underwent rigid bronchoscopy, with removal of the foreign body and confirmation of the suspected nature - an aspirated tooth.
Discussion
Foreign-body (FB) aspiration is a potential harmful situation requiring early detection and intervention. [1]
Although more common in children, adults are also at risk of FB aspiration, especially after trauma with loss of consciousness and of airway protection. Other risk factors include intoxication, intubation or dental procedures. [2]
Clinical features of FB aspiration most frequently include an acute onset of symptoms such as dyspnea, coughing, wheezing, stridor and cyanosis. Rarely, it can be asymptomatic, which could delay the diagnosis.
Chest X-ray is usually the first imaging exam performed, although in many cases aspirated FB is radiolucent. Additionally, it can also show hyperinflation of one lung or lobe, atelectasis, mediastinal shift or pneumomediastinum. Expiratory films are useful on cooperative patients, demonstrating air-trapping on the affected side, and decubitus view could also be used, especially in children or non-cooperative patients, acquired with the suspected side down, showing lack of collapse of the air-trapped lung. [3]
Computer tomography (CT) is superior to x-ray, allowing the detection of smaller or non-opaque FBs and its possible complications.
Bronchoscopy has a dual role in diagnosis and treatment, allowing the removal of the FB. [4]
Flexible bronchoscope is more suitable for small and distally located FBs, and rigid bronchoscope for bigger FB. If unsuccessful, open thoracotomy is an alternative, although rarely performed nowadays due to the effectiveness of endoscopic techniques. [4]
Written informed patient consent for publication has been obtained.
Although more common in children, adults are also at risk of FB aspiration, especially after trauma with loss of consciousness and of airway protection. Other risk factors include intoxication, intubation or dental procedures. [2]
Clinical features of FB aspiration most frequently include an acute onset of symptoms such as dyspnea, coughing, wheezing, stridor and cyanosis. Rarely, it can be asymptomatic, which could delay the diagnosis.
Chest X-ray is usually the first imaging exam performed, although in many cases aspirated FB is radiolucent. Additionally, it can also show hyperinflation of one lung or lobe, atelectasis, mediastinal shift or pneumomediastinum. Expiratory films are useful on cooperative patients, demonstrating air-trapping on the affected side, and decubitus view could also be used, especially in children or non-cooperative patients, acquired with the suspected side down, showing lack of collapse of the air-trapped lung. [3]
Computer tomography (CT) is superior to x-ray, allowing the detection of smaller or non-opaque FBs and its possible complications.
Bronchoscopy has a dual role in diagnosis and treatment, allowing the removal of the FB. [4]
Flexible bronchoscope is more suitable for small and distally located FBs, and rigid bronchoscope for bigger FB. If unsuccessful, open thoracotomy is an alternative, although rarely performed nowadays due to the effectiveness of endoscopic techniques. [4]
Written informed patient consent for publication has been obtained.
Differential Diagnosis List
Aspirated tooth
Other foreign bodies
Calcified tracheal/bronchial lesion
Final Diagnosis
Aspirated tooth
References
[1] Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO (1999) Tracheobronchial foreign bodies: presentation and management in children and adults. Chest May;115(5):1357-62. (PMID: 10334153)
[2] Niraj Kumar, Himanshu Goyal, Ashish Bindra, and Keshav Goyal (2014) Management of aspirated tooth in an adult head injury patient: Report of two cases. Saudi J Anaesth Apr-Jun; 8(2): 276–278. (PMID: 24843346)
[3] Capitanio MA, Kirkpatrick JA (1972) The lateral decubitus film. An aid in determining air-trapping in children. Radiology May;103(2):460-2. (PMID: 5024581)
[4] Niraj Kumar, Himanshu Goyal, Ashish Bindra, and Keshav Goyal (2014) Management of aspirated tooth in an adult head injury patient. Saudi J Anaesth 2014 Apr-Jun; 8(2): 276–278. (PMID: 24843346)
Case information
| URL: | https://www.eurorad.org/case/16104 |
| DOI: | 10.1594/EURORAD/CASE.16104 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 3
Bronchoscopic view
Patient underwent rigid bronchoscopy, with removal of the foreign body and confirmation of the suspected nature - an aspirated tooth.
Figure 4
CT scan
CT confirming a high-density foreign body structure positioned in the origin of the right lateral basal bronchus.
CT scan
CT-scan was performed, revealing a high-density elongated structure located in the trachea, in a dependent position, measuring 24mm x 6mm.
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Sagital view: high-density elongated structure located in the trachea
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Chest x-ray done a few hours later
Bronchoscopic view
Patient underwent rigid bronchoscopy, with removal of the foreign body and confirmation of the suspected nature - an aspirated tooth.
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
CT scan
CT confirming a high-density foreign body structure positioned in the origin of the right lateral basal bronchus.
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal
Department of Radiology, Hospital de Santa Marta, CHLC, Lisboa, Portugal