Nebuliser solution bottle cap presenting as a foreign body in the subglottic airway.

A 58-yr-old obese male with obstructive sleep apnoea and asthma, for which he used nebulised bronchodilators, presented with a 4-month history of wheeze and stridor on both inspiration and expiration. There was a small amount of fresh haemoptysis if he coughed vigorously. A plain chest radio-graph was normal. The patient was treated for an exacerbation of asthma but there was little improvement in his symptoms. A computed tomography scan was performed and a tracheal foreign body shaped like a fish bone was observed (fig. 1). Flexible bronchoscopy revealed a limited view of the foreign object which was wedged in the subglottic portion of the trachea (fig. 2). The foreign object was penetrating the soft tissues and was not amenable to removal using biopsy forceps. It was extracted under general anaesthesia and rigid bronchoscopy. The object was found to be a plastic cap from a nebuliser solution bottle, which the patient reported last using 1 yr previously (fig. 3). Aspiration of a foreign body is more common in children than adults. Aspiration in adults can generally be ascribed to either loss of protective reflexes in the setting of reduced level of consciousness and/or impairment of normal neuromuscular function. Unless there is an immediate severe coughing episode, symptoms FIGURE 1. Computed tomography chest showing tracheal foreign body. FIGURE 2. Bronchoscopy view of the foreign body.