Iron Pill Aspiration Presenting as Bronchial Stenosis: A Case Report

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Tracheobronchial injury from foreign body aspiration has long been described in medical literature, dating back to the first bronchoscopy performed in the late 1800s. Iron pill aspiration can be particularly dangerous due to its ability to create a profound inflammatory response. Iron pill aspiration (IPA) syndrome is described by a history of iron pill aspiration, airway inflammation, and iron particles present on bronchial biopsy. Other supportive findings consistent with iron pill aspiration can sometimes be seen radiographically. We present one case with these findings.

Case Report: An elderly female with history of iron deficiency anemia, dysphagia, and tobacco use presented to her pulmonologist's office for lung nodule follow-up. 2 days prior to her scheduled CT scan, she had an episode of choking on her iron pill, resulting in a productive cough. CT revealed an 8 mm spiculated subpleural nodule within the right lower lobe, as well as narrowing of the left mainstem bronchus and wall thickening concerning for an infiltrative process. PET-CT was obtained for follow up, which revealed increased fluorodeoxyglucose uptake in the right lung nodule and in the narrowed region of the left mainstem bronchus. Bronchoscopy was performed, revealing bronchial stenosis in the left mainstem bronchus, with necrotic, friable, ulcerated material lining the airway. Distal to this, a mild brown exudate was present. The right-sided airways were relatively clear. Biopsy of the necrotic material revealed an ulcer bed with chronic hemorrhage and inflammatory changes, without evidence of malignancy. Also, cultures were positive for Staphylococcus aureus, for which the patient was given antibiotics. Two surveillance bronchoscopes were performed, given the severity of stenosis, for monitoring. These revealed chronic inflammation with edematous, friable, scarred mucosa in the left mainstem bronchus requiring further washing. This patient is currently receiving further workup of her lung nodule.

Discussion: Ferrous sulfate has a unique ability to cause significant injury to the airway due to its interaction with the acidic pH of airway secretions, leading to chemical burn of the bronchial mucosa. A prolonged duration of contact can lead to airway destruction with a subsequent fibrotic healing response, sometimes resulting in bronchial stenosis. The aforementioned case is an example where this was seen. Literature review reveals inconsistent findings on CT with IPA, explained by the varying length of contact and extent of injury. In a patient with risk factors for aspiration, presence of bronchial stenosis on CT can aid with diagnosis of IPA.

Volume

211

First Page

A2020

Last Page

A2020

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A2020

ISSN

1535-4970

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