Clearance of Endo-bronchial Foreign Body by Cough with Epigastric Thrust Prior to Bronchoscopy at the Emergency Department

ABSTRACT

A healthy 72-year-old male was referred to the emergency department (ED) for removal of a foreign body (FB) in the right bronchi from a local medical clinic. The FB was a dental part measuring 5×15 mm in size, which had been accidently aspirated into the lung during a dental procedure. On arrival at the ED, he only complained of mild chest discomfort, and there were no abnormal findings in on physical examination. ED physicians prepared bronchoscopic FB removal while the patient rested in bed. During the wait for bronchoscopy, the patient felt discomfort in the chest and epigastric area, and then he coughed forcefully and at the same time, epigastric thrust was performed with his fist. After several strong coughs with epigastric thrusts, the FB was expelled from his mouth. Chest roentgenogram showed no FB, and the patient was discharged from the ED with no complications. Bronchoscopy has been the only treatment option for bronchoscopic FB, and self-removal of FB is rare. This case report may be helpful to understanding a possible mechanism of self-clearance of FB in some healthy adult patients with a small-sized endobronchial FB.