CTICasesTracheobronchial Foreign Body Aspiration (Aspirated Tooth)
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Imaging findings
Daily portable chest radiographs in an intubated ICU patient show progressive right lower and middle lung opacities with multiple distinct pleural/fissural interfaces and displacement of the interlobar fissures, accompanied by a newly appeared, small, radiopaque structure projecting over the right main bronchus. CT and bronchoscopy confirm a broken tooth fragment completely obstructing the bronchus intermedius, leading to lobar atelectasis.
Key takeaways
Obstructive lobar atelectasis in semi-recumbent ICU patients is easily misdiagnosed as pleural effusion or simple dependent atelectasis. Displaced fissures and multiple interfaces on a radiograph are clues for lobar collapse. Broken or dislodged teeth are a known hazard of endotracheal intubation, and when identified in the airway, they require prompt bronchoscopic extraction.
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