Airway Foreign Body-Leave Nothing Behind

A middle-aged male presented with chronic cough, shortness of breath and fever. In the presence of wheeze and mild right-sided opacities on chest x-ray, he was treated for infective exacerbation of asthma with nebulised bronchodilators, antibiotics and steroids. Due to persistent wheeze, a contrasted computed tomography (CT) scan was done and revealed the presence of two endobronchial linear foreign body (FB) opacities, the second located more distally than the first. A rigid bronchoscopy-based technique under general anaesthesia was used to remove the first FB, and flexible bronchoscopy via endotracheal tube was used for the second FB in the same session. This case illustrates the tenets of airway FB diagnosis and management. The differential diagnosis of radiolucent airway FB needs to be considered in patients with chronic symptoms. Rigid and flexible bronchoscopy techniques are complementary. Peripheral lesions are more accessible by flexible bronchoscopy. Measures to ensure complete removal of FBs must be consistently incorporated into routine practice.