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A 57-year-old woman with carcinoid syndrome was referred to the pulmonary clinic by
her primary care physician (PCP) for persistent cough for the past 6 weeks. She was
evaluated by her PCP approximately 6 weeks earlier for cough, which the patient thought
started after she had aspirated one of her medications. Results from initial clinical
evaluation and chest radiography done by her PCP were normal. When we evaluated, her
vital signs were within the normal range. She had wheeze on chest auscultation. Because
she had several weeks of persistent cough and likely had aspirated a pill, we decided
to proceed with bronchoscopy. Aspirated material was found in the right lower lobe.
Black fragments were seen, and intense inflammatory reaction with granulation tissue,
leading to bronchial stenosis, was noted (Figure). Histology showed benign bronchial cells with numerous inflammatory cells and alveolar
macrophages, and foreign material consistent with iron was seen on iron stain, which
was consistent with iron pill aspiration. The patient was referred for advanced bronchoscopy
and endobronchial interventions because of the extent of bronchial tissue injury and
stenosis.
FigureBronchoscopy showing pill fragments (arrow) with intense inflammatory granulation
response with bronchial stenosis.
