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CASE REPORTCytology and histology of a potential life-threatening airway injury

Vanessa HenriquesLucília Monteiro

Clinical History

• 90 years-old male

• Bedridden

• Previous thoracic trauma with lung perforation

Presented to the ER with:

Dyspnea, thoracalgia, vomiting.

Lymphocytosis

Elevated RCP Chest X-ray on admission: Right hilum and lower lobe opacities.

Chest X-ray on 10th day after admission:Right hilum and lower lobe hypotransparency.

Chest CT Scan: Right lower lobecollapse and pleural effusion.

Day 10 of Antibiotics

Right main bronchus: slightly elevated, yellow and friable with easy bleeding.

Bronchoscopy

Right bronchus branching: yellowish and necrotic aspect.

Necrotic background

Golden-Brown fibrils

Sputum Cytology

Squamous cells with reactive features.

Sputum Cytology

Yeasts and

Hyphae

Sputum Cytology

Necrosis

Golden-brown fragments

Bronchial Biopsy

Fibrillary and

Birefringent deposits

Bronchial Biopsy

Hyphae morphologicallysuggestive of Candidaspp.

Bronchial Biopsy

Squamous cell metaplasia

Residual iron fragments under squamous cell metaplasia

Perls Stain

Bronchial Biopsy

Patient medication history?

Oral iron supplementation was prescribed during admission.

DIAGNOSIS

Iron pill Aspiration Bronchitis

• 32 cases published (mean age of 68 y-o)

• > 50% patients did not realise the aspiration event

• Clinical presentation commonly non-specific: 8 haemoptysis 2 fatal

• Diagnosis relies on biopsy and medication history

• No foreign body identification Chemical burn!

Literature Review

CoughHaemoptysisChest pain

Persistent coughDyspnoeaAsymptomatic

Friable mucosaYellowish-brown colorHemorrhage

Bronchial stenosis

CLINICAL PRESENTATION

BRONCHOSCOPY

CYTOLOGYBIOPSY

Necrotic mucosaGolden-brown fibrils Squamous metaplasia

Granulation tissueIron depositsFibrous tissue

Literature Review

ACUTE PHASEDays / weeks

CHRONIC PHASE> 2 Months / Year

Thank you for your attention!

Lisbon, Portugal