DOI QR코드

DOI QR Code

A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration

  • Kwak, Joo-Hee (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Koo, Gun Woo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Chung, Sung Jun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Park, Dong Won (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Kwak, Hyun Jung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Moon, Ji-Yong (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Kim, Sang-Heon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Sohn, Jang Won (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Yoon, Ho Joo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Shin, Dong Ho (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Park, Sung Soo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Pyo, Ju Yeon (Department of Pathology, Hanyang University College of Medicine) ;
  • Oh, Young-Ha (Department of Pathology, Hanyang University College of Medicine) ;
  • Kim, Tae-Hyung (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University College of Medicine)
  • 투고 : 2014.08.20
  • 심사 : 2014.09.24
  • 발행 : 2015.10.30

초록

Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury.

키워드

참고문헌

  1. Hill SN, Main AN, Fuggle WJ. Covert inhalation of tablet causing fatal pneumonia. Postgrad Med J 1988;64:66-7. https://doi.org/10.1136/pgmj.64.747.66
  2. Tarkka M, Anttila S, Sutinen S. Bronchial stenosis after aspiration of an iron tablet. Chest 1988;93:439-41. https://doi.org/10.1378/chest.93.2.439
  3. Lamaze R, Trechot P, Martinet Y. Bronchial necrosis and granuloma induced by the aspiration of a tablet of ferrous sulphate. Eur Respir J 1994;7:1710-1. https://doi.org/10.1183/09031936.94.07091710
  4. Cimino-Mathews A, Illei PB. Cytologic and histologic findings of iron pill-induced injury of the lower respiratory tract. Diagn Cytopathol 2013;41:901-3.
  5. Delgado-Sanchez L, Atwal P, Krishnan P. Iron pill induced bronchitis. Int J Case Rep Imag 2012;3:34-6.
  6. Lee P, Culver DA, Farver C, Mehta AC. Syndrome of iron pill aspiration. Chest 2002;121:1355-7. https://doi.org/10.1378/chest.121.4.1355
  7. Godden DJ, Kerr KM, Watt SJ, Legge JS. Iron lung: bronchoscopic and pathological consequences of aspiration of ferrous sulphate. Thorax 1991;46:142-3. https://doi.org/10.1136/thx.46.2.142
  8. Aust SD, Morehouse LA, Thomas CE. Role of metals in oxygen radical reactions. J Free Radic Biol Med 1985;1:3-25. https://doi.org/10.1016/0748-5514(85)90025-X
  9. Kim ST , Kaisar OM, Clarke BE, Vandenburg RA, Allen DH, Bell SC, et al. 'Iron lung': distinctive bronchoscopic features of acute iron tablet aspiration. Respirology 2003;8:541-3. https://doi.org/10.1046/j.1440-1843.2003.00506.x

피인용 문헌

  1. Acute Pulmonary Coccidioidomycosis and Review of Published Cases with Lung Involvement in Korea vol.21, pp.2, 2015, https://doi.org/10.15746/sms.15.037
  2. Iron pill aspiration: Cytologic and histologic findings of a potential life‐threatening airway injury. A Case report and literature review vol.46, pp.6, 2015, https://doi.org/10.1002/dc.23886