Syndrome of iron pill inhalation in four patients with accidental tablet aspiration: Severe airway complications are described

Abstract

Iron pill inhalation represents a uncommon cause of syntomatic endobronchial foreign bodies. Unlike foreign body, the direct contact of iron tablet onto the bronchial mucosa results in severe bronchial damage in addition to obstruction and local irritation. Four patients with Iron Pill Inhalation Syndrome are described. All but one patient developed irreversible bronchial stenosis as late post inflammatory complication. Bronchoscopic features and clinical evolution are described in order to reduce the risk of severe side-effects in patients highly suspected for iron pill aspiration.

Iron pill aspiration: Cytologic and histologic findings of a potential life‐threatening airway injury. A Case report and literature review

“…Bronchoscopy examinations performed in the acute phase, consistently revealed a yellow‐brown discolored, necrotic mucosa, occasionally forming a polypoid mass, markedly friable with easy bleeding when touched . Necrosis, inflammation, and pigments were reported to last up to two months …”

“…In eight cases, it was still possible to identify and remove the pill through bronchoscopy, thereby preventing complications . In the chronic phase, the most commonly reported complications were bronchial stenosis and lung atelectasis.…”

“…In only 50% of the cases the aspiration event was noticed by the patient or recalled after a detailed clinical history taken retrospectively. 6,7,[9][10][11]13,14,19,22,23,27 The most frequent symptoms in the acute phase, defined as the first two weeks after the aspiration event, where coughing (53%), four patients presented with brown sputum and eight with obvious hemoptysis. 12,13,19,20,23,25 Two cases presenting with hemoptysis were fatal due to massive lung haemorrhage.…”

“…Other less common symptoms were pleuritic pain and burn sensation, reported in six cases, and epigastric discomfort. 7,9,14,20,[23][24][25] Inflammation associated with brown tablet remnants lasted for 10 days. Two months later there was granulation tissue.…”

“…7,10,25 Bronchoscopy examinations performed in the acute phase, consistently revealed a yellow-brown discolored, necrotic mucosa, occasionally forming a polypoid mass, markedly friable with easy bleeding when touched. [7][8][9][10]12,13,15,19,20,[23][24][25] Necrosis, inflammation, and pigments were reported to last up to two months. 14,[20][21][22] Including our case, three other cases had cytologic specimens collected along with biopsy.…”