PMC9260293_01
Chest computed tomography (CT) shows an orthodontic appliance lodged in the left main bronchus. Anterior (a, blue arrow) and posterior portions (b, blue arrow) of the appliance appear to be embedded in the bronchial wall. (c) Three-dimensional-CT reveals the structure of the foreign body and relationship with the left main bronchus more clearly. The coronal view (d, red arrow) of contrast-enhanced chest CT shows the anterior site of foreign body embedded near the left main pulmonary artery. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Fig. 1 shows the CT images obtained at our institution (Fig. 1A and B) and three-dimensional (3D) CT (shown in Fig. 1C).
Virtual reality (VR) images from the left main bronchus inlet clearly show the structure of the foreign body and can be used to evaluate it from all angles (the blue arrow indicates the anterior portion, red arrow the posterior portion, and yellow arrow the left main bronchus) (a). Using a controller, specific structures (e.g., only bronchus and pulmonary artery) could be selected and evaluated internally through the left main bronchus (b). Features like "resolution" and "ability to zoom" can help operators understand the anatomy of it, and they suggested that the anterior and posterior sides were both buried and difficult to remove. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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It suggested that both proximal sides and one part of the posterior side (mediastinal space side) of the appliance had grown into the bronchial mucosa (shown in Fig. 2) and a granulation tissue had formed around it.
(A) Insulation-tipped diathermic knife (IT knife) (indicated by blue arrow) was used to cut the bronchial wall at the proximal embedded site (indicated by red arrow). (B) The foreign body was removed by rigid forceps (indicated by blue arrow). (C) The retrieved orthodontic appliance. (D) Duplicated appliance for reference. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Second, we excised the granulation tissue at the proximal side using the IT knife as the cut section faced the mucosa vertically (shown in Fig. 3A). Thereafter, the mobility of the foreign body improved, and it was removed using grasping forceps under rigid bronchoscope guidance (shown in Fig. 3B).