Animal Bone Extraction Using Flexible Bronchoscopy Presenting as Broncholith in a Previously Treated Chronic Obstructive Pulmonary Disease Patient: A Case Report

Abstract

Abstract A 72-year-old Filipino male, 13 pack year smoker, with hypertension, type 2 diabetes mellitus (T2DM), and previous treatment completed for pulmonary tuberculosis (PTB) in 1990s, presented with chronic non-productive cough for 5 years, worse at night when lying down. He was initially managed as a case of chronic obstructive pulmonary disease (COPD) however, still with persistent respiratory symptoms and recurrent pneumonia on chest xrays. Further work-ups were done and showed mild obstruction with no significant bronchodilator response in spirometry. Chest computed tomography scan showed broncholith over the right bronchus intermedius extending to the right lower lobe. Flexible bronchoscopy was done to extract the broncholith, however, upon visualization, a hard solid mass was noted which turned out to be a beef bone. The foreign body was successfully extracted using flexible bronchoscopy with rat forceps and subsequent extubation and removal of the bronchoscope as a single unit. This case shows the importance of correlating computed tomography findings with bronchoscopy in a patient with a worsening chronic cough despite good compliance with multiple medications and inhalers. The importance of utilizing the proper instruments such as forceps, snares, and baskets during bronchoscopy and cryotherapy is emphasized in this case.