case_images: PMC10958796_01
case_images: (a) The foreign body in the right lower lobe. (b) The plastic pen cup whose edges of the tail have been chewed up.
case_images: 10.1177_2050313X241241216-fig1.jpg
case_images: PMC10958796_01_10.1177_2050313X241241216-fig1.jpg
case_images: fig1-2050313X241241216
case_images: The computed tomography (CT) of the chest showed an opacity in the right lower lobe, arousing suspicion of TFB (Figure 1(a)). The TFB was confirmed to be a pen cap, about 15 mm in length and 8 mm in diameter, the edges of the tail had been damaged by forceps (Figure 1(b)).
case_images: PMC10958796_02
case_images: (a) The foreign body in the subglottic. (b) The foreign body in the right main bronchus. (c) Metal pen cap foreign body. (d) Recovery of the neck incision.
case_images: 10.1177_2050313X241241216-fig2.jpg
case_images: PMC10958796_02_10.1177_2050313X241241216-fig2.jpg
case_images: fig2-2050313X241241216
case_images: The chest CT of the local institution showed a cone-looking opacity in the subglottic, indicating a suspicion of a TFB (Figure 2(a)). Auscultation of the lungs suggested that the TFB might have moved, rechecked chest CT proved that the foreign body had migrated to the right main bronchus (Figure 2(b)). To avoid a second surgery, we took tracheotomy to remove TFB which turned out to be a pen cap (Figure 2(c)). The patient recovered healthily and only a thin neck scar remained (Figure 2(d)).
case_images: PMC10958796_03
case_images: (a) The foreign body with part of the edge impacted into the surrounding edematous mucosa under endoscopy. (b) The bronchial fistula under endoscopy. (c) Broken plastic pen cap foreign body.
case_images: 10.1177_2050313X241241216-fig3.jpg
case_images: PMC10958796_03_10.1177_2050313X241241216-fig3.jpg
case_images: fig3-2050313X241241216
case_images: We found that the right bronchus mucosal was hyperemia and edema but with no foreign body, but a hollow-cone foreign body was found in the left main bronchus with part of the edge buried into the surrounding edematous mucosa (Figure 3(a)). Further attempts were made, but the procedure had to be aborted due to the development of a bronchopleural fistula illustrated by rigid bronchoscopy (Figure 3(b)). TFB had migrated into the thorax, the Pediatric Cardiothoracic Operation Service suggested performing the left anterolateral thoracotomy. The TFB was removed by bronchotomy (Figure 3(c)) and the bronchial fistula was repaired simultaneously.