Spontaneous reexpansion of lung tissue after chronic atelectasis due to a stenotic airway

Chronic atelectasis is a commonly reported complication of bronchial stenosis and airway obstruction. Bronchial stenosis after aspiration of oral medications has been reported in the literature many times. Spontaneous reexpansion of lung tissue after chronic atelectasis due to a stenotic airway is an unusual and unreported phenomenon. We present the case of a 72-year-old woman with documented history of chronic left lower lobe atelectasis due to bronchial stenosis from aspiration of an iron tablet 2 years before the current presentation. Two days after the initial aspiration event, a bronchoscopy was performed with the retrieval of an iron tablet from her left mainstem bronchus (LMB) using saline lavage and suctioning. This appeared successful at the time of the procedure. Repeat imaging of the chest and 2 diagnostic bronchoscopies over the following 2 years revealed near-complete atelectasis of the left lung with occlusion of the LMB. In September 2008, she presented with worsening shortness of breath. On examination, she had absent breath sounds at the left lung base. A chest computed tomography scan revealed scarring of the LMB and left lower lobe atelectasis with improved aeration notable in parts of the lung previously documented to have collapsed. A bronchoscopy revealed an approximately 90% stenosis of the left mainstem LMB. Balloon dilation was performed; although there was significant bronchoscopic improvement noted, the patient did not report any relief of her symptoms from the procedure.