Cryotherapy Can Help Remove Foreign Objects from Lungs, Study Shows

   According to researchers at Louisiana State University in Shreveport, Louisiana, foreign bodies (FB) often enter the body through oral cavities, and their retrieval can be difficult. However, novel technologies are providing unique ways to remove them.

   Adam Wellikoff, MD, and colleagues at Louisiana State University in Shreveport, Louisiana, demonstrated a flexible cryoprobe at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, in Honolulu. They described the case of a 57-year-old woman who presented with dyspnea initially attributed to worsening of her chronic obstructive pulmonary disease.

   But a CT scan showed a 2cm linear, metallic FB in the bronchus of the left lower lung (without erosion through the bronchial wall or parenchymal changes). The patient underwent flexible bronchoscopy in an attempt to remove the object using endobronchial forceps and snares; that failed. The FB appeared to be sharp and was barely pushing into the bronchial mucosa. The position and smooth, metallic material made grabbing the object difficult. Given the lack of urgency and significant sedation required, the procedure was aborted.

   She was admitted and given several days of antibiotics and inhaled bronchodilators, including inhaled steroids. Another bronchoscopy was performed under general anesthesia and, this time, endobronchial cryotherapy used. The cryoprobe was positioned so the tip contacted the FB. It then was used to pull the tip of the FB away from the mucosa and lift it out of position. Forceps were then used to extract it. The FB turned out to be a push pin that she had recalled holding in her mouth the week before, but did not recall choking.

   According to Dr. Wellikoff and colleagues, only one other case was found in the literature using cryotherapy to extract a metallic FB. “Due to the slippery nature of smooth-surfaced metallic objects, conventional means can fail in retrieval,” they concluded. “This case shows that cryotherapy may be employed when dealing with these objects to facilitate removal.”