AN EGG IN THE LUNG

Abstract

CASE PRESENTATION: A previously healthy 88-year-old male who recently moved to the US from China presented for hyperkalemia and elevated creatinine found during a primary care visit. Shortly after admission, the patient developed progressive hypoxia resulting in cardiac arrest secondary to acute hypoxic respiratory failure. He achieved return of spontaneous circulation (ROSC) quickly without intubation. The witnessing nurse described that the patient had choked and ultimately lost consciousness prior to the event. 2 days later, oxygen requirements continued to increase requiring BiPAP. Due to a lack of adequate response to BiPAP, he was intubated. CT chest with contrast was done and was negative for pulmonary embolism, however showed atelectasis of the right lower lobe. The patient underwent flexible bronchoscopy showing a spherical foreign body (FB), 10 mm in diameter in the bronchus intermedius causing complete obstruction. This was removed using forceps and a cryotherapy probe. The FB grossly appeared to represent a small egg. Microscopic examination showed necrotic material of organic and non organic origin. Due to worsening clinical condition, family withdrew care and patient passed away.