PMC8348218_01
A and B are chest X-rays at one month before admission at our hospital and on admission, respectively. C and D are computed tomography (CT) images on admission. (A) Chest X-ray showed right-sided pleural effusion, and the trachea can be seen on the midline. (B) The pleural effusion decreased but still remained. The trachea shifted slightly toward the effusion. (C, D) Chest CT revealed an isodense lesion in the right bronchus intermedius, right-sided pleural effusion, atelectasis in the middle lobes, and a peribronchovascular shadow in the lower lobes.
gr1.jpg
PMC8348218_01_gr1.jpg
fig1
The patient received the diagnosis of heart failure at another hospital one month prior to his current presentation based on a right-sided pleural effusion on chest X-ray (Fig. 1A), pitting leg edema and his medical history. Chest X-ray showed decreased but persistent, right-sided pleural effusion and an infiltration shadow in the right lower lung (Fig. 1B). Chest computed tomography visualized an isodense lesion in the right bronchus intermedius, right-sided pleural effusion, atelectasis in the middle lobes, and a peribronchovascular shadow in the lower lobes (Fig. 1C and D).
Time course of appearance of the right bronchus intermedius. On admission, bronchoscopic examination revealed the pill-like object obstructing the bronchus (A), and golden-yellow and hemorrhagic bronchial lumen showing near-total obstruction after removing the object (B). Persistent bronchial stenosis 1 month after pill removal (C). . (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
gr2.jpg
PMC8348218_01_gr2.jpg
fig2
Although the patient failed to recall any episode of pill aspiration, bronchoscopy was performed to investigate the endobronchial lesion on suspicion of pill aspiration or a malignancy and revealed total obstruction of the right bronchus intermedius by a foreign body with an elliptical shape (Fig. 2A). The endobronchial mucosa was golden-yellow in color, necrotic, and edematous with marked contact bleeding (Fig. 2B). However, the bronchial stenosis persisted despite repeated balloon dilation (Fig. 2C), and the patient finally died of severe obstructive pneumonia two years later.