Foreign Body in the Lung

For 1 month, an 82-year-old woman had had episodes of coughing. Chronic bronchitis had been diagnosed; however, antibiotics and bronchodilators failed to control symptoms.

The patient was admitted to the hospital with worsening dyspnea and a 10-lb weight loss that had occurred during the past 3 months. There was no history of hemoptysis. She had smoked cigarettes for 30 years.

Drs Manjula Thoprechela, Sonia Arunabh, and Arunabh of North Shore University Hospital in Forest Hills, NY, report that wheezing was heard most prominently on the left side of the chest. Vital signs were stable. A chest film demonstrated a foreign body in the region of the left main-stem bronchus (arrow). Apparently, the patient had swallowed a loose tooth during sleep a few weeks earlier. Bronchoscopy confirmed the presence of a tooth in the left main-stem bronchus. The foreign body was removed; the patient's cough improved significantly.

In clinical practice, chronic cough usually is considered a manifestation of bronchospasm in conditions such as bronchial asthma. Keep in mind, however, that a cough can be initiated by a variety of airway irritants, which enter the tracheobronchial tree either by inhalation (eg, smoke, dust, and fumes) or by aspiration (eg, upper airway secretions and gastric contents). Any irritant that causes inflammation of the tracheobronchial tree can produce cough. Consider all these diagnostic possibilities when examining patients with chronic cough. Chest films and CT scans may be helpful in confirming the cause.