Grassheads in the Tracheobronchial Tree: Two Different Outcomes

Abstract

Many vegetable foreign bodies can produce serious pulmonary complications because of chemical irritation to the airway. Barley grass, a type of grasshead, does not induce such a reaction because of its resistance to organic decay. Complications which may occur are illustrated by the clinical course of two patients with aspiration of this foreign body. In the first patient the grasshead entered the trachea with the flowering unit first and the stem following. In the second patient the stem entered the trachea first. Recurrent pneumonias were noted in the first patient. Despite its presence in the right stem bronchus for three years, no further episodes of pneumonia followed its removal. In the second patient the grassheads could not be removed endoscopically. They migrated into the right lower lobe producing pneumonia and ultimately resulting in a brain abscess. The difference of entry of the same foreign body into the trachea, stem first versus flowering unit first, is an essential factor in altering the clinical outcome.

Airway foreign bodies and brain abscesses: Report of two cases and review of the literature

“…When patient 2 developed antibiotic-associated neutropenia, because of residual neurologic abnormality, the antibiotic was changed to vancomycin and a 6-week course of therapy was completed. [6] Although the bacteriology of the brain abscesses discussed here is quite varied, all are common flora of the oropharynx. This supports a route of infection with origins in the aerodigestive tract.…”

“…Other predisposing factors include bronchiectasis, cystic fibrosis, esophageal dilatation and endocarditis [2]. A review of the medical literature found only four reported cases of a brain abscess secondary to an airway foreign body [3][4][5][6].…”

Foreign Body Aspiration: Imaging Aspects

“…When inhaled stump-first, the spikes carry the grass heads distally into the bronchial tree and lung parenchyma. Being resistant to organic decay, they can remain in the chest for a long time and can cause unusual infections, as well as other complications (Spencer et al 1981;Maayan et al 1993;Dindar et al 1994;Basok et al 1997;Newson et al 1998;Ammari et al 2000).…”

“…The presence of a bronchial foreign body of long duration causes atelectasis that can become infected and lead to the development of bronchiectasis. This can become so severe that bronchoscopic extraction of the foreign body might not be possible, and surgical treatment may eventually be required (Spencer et al 1981;Gatch et al 1987;Maayan et al 1993;Nikolaizik and Warner 1994;Cataneo et al 1997;Scully et al 1998;Karakoc et al 2002;Adegboye et al 2003).…”

“…Brain abscesses have been reported in association with foreign body aspiration, presumably due to faulty pulmonary capillary filter mechanisms (Spencer et al 1981;Sane et al 1999;Fuentes et al 2001;Shachor-Meyouhas et al 2009;Dabbah et al 2009).…”