Flexible bronchoscopic removal of a distal bronchial foreign body with cinefluoroscopic guidance.

A 15-year-old girl presented to the emergency department with cough and bloody sputum. A chest radiograph demonstrated a radiopaque foreign body (a tongue stud) in the right lower lobe. Rigid and flexible bronchoscopy failed to localize the foreign body. Under fluoroscopic guidance, the foreign body was identified in a right lower lobe distal bronchus; it could be visualized from a distance with a 3.5-mm flexible bronchoscope. An endobronchial biopsy forceps was passed through the suction port of the bronchoscope, but the view of the foreign body was obstructed by the biopsy forceps. The bronchoscope could not be advanced closer to the foreign body, because its diameter was greater than that of the bronchus. Under cinefluoroscopic guidance, the endobronchial biopsy forceps was then used to remove the foreign body. A chest radiograph obtained after removal was normal. The patient was discharged home the following day. Removal of distal bronchial foreign bodies can be challenging, because the bronchial diameter may preclude the advancement of the bronchoscope. Cinefluoroscopy is a relatively safe therapeutic adjunct that may avert the need for thoracotomy.