# Difficult removal of an endobronchial foreign body: pen cap aspiration: a case report

## TL;DR

A 12-year-old boy had a pen cap aspirated into his lung, which was difficult to remove and initially mistaken for a magnetic bead.

## Contribution

This case highlights the challenges in diagnosing and removing foreign bodies in the airways, especially when symptoms are subtle.

## Key findings

- The aspirated foreign body was a pen cap, not the initially suspected magnetic bead.
- Combination bronchoscopic techniques were necessary for successful removal due to the foreign body's location and retention time.
- Delayed diagnosis and treatment can lead to serious complications like recurrent pneumonia or life-threatening conditions.

## Abstract

Foreign body aspiration represents an important cause of morbidity and mortality during childhood. Foreign body aspiration is often missed clinically, especially in some children whose symptoms and signs are not obvious. A neglected aspirated foreign body can last for years, leading to recurrent pneumonia in mild cases and the potential to be life-threatening in severe cases. We herein report a case of difficult foreign body removal in the left upper lobe to help us better understand the risk of foreign body aspiration.

The patient was a 12-year-old boy of East Asian ethnicity who complained of a history of magnetic bead aspiration 17 days earlier. He was admitted to hospital due to fever 5 days previously with a mild cough and chest pain. Chest computed tomography confirmed a bronchial foreign body. Due to the special location of the foreign body impaction and prolonged retention, it was very difficult to remove. We successfully removed the peripheral granulation tissue with the help of a combination of various bronchoscopic interventional techniques and finally removed the foreign body. However, to our surprise, the foreign body was not a magnetic bead but a pen cap.

Foreign body aspiration is common in childhood and requires early recognition and treatment to avoid complications that can be very serious or even fatal. Bronchoscopy is the gold standard for the diagnosis of foreign body aspiration. For difficult foreign body removal, bronchoscopic intervention technology can be useful.