Cayenne aspiration: an unusual type of lower airway foreign-body aspiration

Abstract

PurposeCayenne aspiration is an unusual type of foreign-body aspiration that is usually misdiagnosed. This article analyzes the clinical features of cayenne aspiration in the lower airway.Patients and methodsClinical data on eight adult patients with cayenne aspiration were retrospectively analyzed. Six were elderly patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2010 and August 2014.ResultsThe most common symptoms of cayenne aspiration were cough (eight cases, 100%) and sputum (five cases, 62.5%). Only one patient (12.5%) could supply the history of aspiration on his first visit to doctor and was diagnosed definitely without delay. The other seven cases were misdiagnosed as pneumonia and the time to accurate diagnosis was from 1 month to 6 months. The history of aspiration could be recalled after confirmed diagnosis for the other seven cases. The most common presentation shown by chest computed tomography (CT) was pneumonic opacity (eight cases, 100%). The existence of cayenne could not be detected by chest CT in any of the patients. All the patients were diagnosed definitively and managed successfully with flexible bronchoscopy. Cayenne was more often lodged in the right bronchus tree (seven cases, 87.5%), especially the right lower bronchus (four cases, 50%). The segment of cayenne was complete in five cases (62.5%) and scattered in three cases (37.5%).ConclusionThe clinical features of cayenne aspiration are usually obscure and nonspecific which may lead to delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management.

Missed Foreign Body Diagnosis in a 3 Month Old Infant with Pneumonia: Case Presentation

“…The diagnosis in this child was delayed for about 72 hours after admission. Delays in diagnosis have also been reported by various authors, and the duration of delay may be as long as 1 to 6 years [7,8].…”

“…Even CT may produce a false negative result in the presence of a foreign body depending on the physical properties of the aspirated material and the slice thickness relative to the size of the foreign body. Therefore, direct visualization of the airways by bronchoscopy is advocated [7].…”

“…A situation where history to suggest aspiration is obtained only after the diagnosis has been made has also been reported from China [7]. Furthermore, not all parents or caregivers may witness or remember the choking episode.…”

Wheezing of unexpected etiology: A case report of pea aspiration mimicking bronchus obstruction caused by a tumor

“…However, some geriatric patients do not have cough or lack the cognitive capacity to inform of an episode of FBA. Lin et al reported that only 29% of geriatric patients can declare an event of aspiration [ 4 ]. Furthermore, the asymptomatic period from the timing of aspiration can be longer than the following symptomatic period [ 5 ].…”

CT characteristics of bronchopulmonary abnormalities caused by pepper aspiration

“…Others include iatrogenic objects such as endodontic needles, tracheostomy tube segments, endotracheal tube appliances, and miscellaneous items such as thumbtacks, pins, rivets, etc [13] . Among them, a few foreign bodies such as coins, nails, and teeth are radiopaque, thus they appear hyperdense in computed tomography (CT) scan and can be easily detected and identi ed [8,[14][15][16] . However, most organic foreign bodies are radiolucent and are unlikely to be detected directly by chest CT [8,12,15,17] .…”