Bronchoscopy: diagnosis and management of pill aspiration
Bronchoscopy is critical for diagnosis and management of pill aspiration. Flexible bronchoscopy was performed in 12 of the cases described here and may be particularly helpful in the acute setting to minimize the deleterious effects of a partially or completely dissolved pill. Additional tools, including forceps, snares, baskets, and balloon catheters, can be useful for extracting the aspirated pill. A cryotherapy probe may also be used to aid in the extraction of aspirated pills. In one case of likely aspiration of an unknown tablet, no bronchoscopy was performed, and impacted material in the right lower lobe was discovered after the patient died from an unrelated cause. In the series of cases reported here, two patients received short courses of corticosteroids. The effectiveness of corticosteroids in reducing airway complications following identification of a pill aspiration injury is unknown.
Rigid bronchoscopy was used in several cases to remove the aspirated pill and treat the sequelae of the initial airway injury. Surveillance bronchoscopy plays an important role in assessing for evolving airway obstruction due to edema, secretions, and stenosis. In the second case described in this report, complete occlusion of multiple segments of the right lower lobe occurred within 1 month of diagnosing the injury and approximately 3 months after the initial injury. This time course highlights the importance of continued surveillance of the abnormal airway. These complications can be treated successfully with endobronchial therapies when identified early. A number of endobronchial therapies have been used, including forceps debridement, cryodebridement, laser photoresection, balloon dilation, and mitomycin C application.
Overall, endobronchial therapy appears to be quite successful. Of the previously reported cases, underwent bronchoscopy. Aspiration of secretions and tablet removal were the most commonly performed procedures. A number of other endobronchial techniques were used to preserve airway integrity. One patient required emergent tracheostomy for airway management, and a second patient underwent emergent surgery for bronchial necrosis 9 days after the initial event. This latter case is the only reported death, to our knowledge, due to pill aspiration. Two patients underwent elective surgery (lobectomy and bilobectomy) for stenosis and airway occlusion. In these cases, no endobronchial therapy was used beyond flexible bronchoscopy and aspiration of secretions.
