Missing piece: tracheobronchial foreign body aspiration during an elective thyroidectomy

Airway management during thyroid surgery is challenging, particularly in patients with altered upper airway anatomy that may impair laryngoscopic visualisation. Bougies are commonly used to aid difficult intubation, but in rare cases, they can fracture and lead to tracheobronchial aspiration. We report the case of a woman in her mid-50s with multinodular goitre suspicious for malignancy who underwent elective thyroidectomy. Difficult intubation necessitated bougie use, but postoperatively, its tip was found missing. Chest CT confirmed the fragment lodged in the right lower lobe bronchus. The patient was transferred to our institution, where flexible bronchoscopy successfully retrieved the 2.5 cm fragment. Her cough resolved, and aside from post-thyroidectomy hypocalcaemia, her recovery was uneventful. Bougie fracture during intubation is extremely rare but should be considered in difficult airways. Early recognition, prompt imaging and bronchoscopy are crucial for management. Routine device inspection and careful procedural planning are key to preventing such complications.