Asymptomatic near-total airway obstruction by a cylindrical tracheal foreign body.
OBJECTIVE
The objective was to present the unique case of previously unreported asymptomatic cylindrical tracheal foreign body causing near-total airway obstruction. The asymptomatic nature of the case made diagnosis and management challenging.


METHODS
A retrospective case review at an urban health maintenance organization medical center.


METHODS
A 3.5-year-old asymptomatic boy was incidentally discovered to have a metallic foreign body in his mid trachea on a screening scoliosis roentgenogram. He underwent rigid bronchoscopic retrieval the following day.


RESULTS
The foreign body was found to be a corroded, 9 x 6-mm metallic cylinder with a narrowed luminal diameter of 2.0 mm. Intubation was maintained in the pediatric intensive care unit for 48 hours, and extubation was performed in the operating room under direct bronchoscopy. Mitomycin C was applied to a circumferential area of denuded tracheal mucosa.


CONCLUSIONS
Tracheal foreign bodies are distinctly different clinical entities from bronchial foreign bodies. Asymptomatic bronchial foreign bodies are relatively common, but to the authors' knowledge, an asymptomatic tracheal foreign body had not been reported previously. Discussion focused on pathophysiology with reference to Poiseuille's law, diagnosis, and management of asymptomatic tracheal foreign bodies, including the possibility of elective bronchoscopic retrieval.
Mathiasen
Ronald A
RA
Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California 94611, USA. DoctorRam@aol.com
Cruz
Raul M
RM
D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001999:Bronchoscopy; D002675:Child, Preschool; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D011859:Radiography; D014132:Trachea / Q000000981:diagnostic imaging