May 2025 Medical Image of the Month: Aspirated Dental Screw

Figure 1. Portable AP chest Xray (A) demonstrating a metallic density projecting over the right hilum. A follow-up chest Xray obtained after bronchoscopy (B) shows that the item is no longer present. Endoscopic view of the right middle lobe bronchus during bronchoscopy (C) and post-retrieval photograph demonstrate a metallic dental screw. To view Figure 1 in a separate , enlarged window click here.

An 80-year-old man with no significant past medical history presented to the emergency department with cough following a routinedental procedure. He reported intermittent coughing but denied chest pain, shortness of breath, palpitations, or dizziness. On physical examination, he appeared comfortable, with stable vital signs and no signs of respiratory distress. Cardiovascular, respiratory, and neurological examinations were unremarkable. A chest radiograph (Figure 1A) revealed a metallic foreign body in the right main bronchus. Laboratory investigations were within normal limits. Given the radiologic findings and stable clinical status, the patient was intubated and underwent flexible bronchoscopy. The procedure revealed a grayish metallic foreign body lodged in the right middle lobe bronchus (Figure 1C), which was successfully removed using a snare technique. No bleeding, trauma, or complications were observed. The extracted object measured 2.5 cm (Figure 1D) and appeared as a silver metallic dental screw with a sharp, broad base. Bronchial secretions were minimal and suctioned during the procedure.

Foreign body aspiration in adults is relatively rare and often presents with nonspecific symptoms such as cough, wheezing, or dyspnea. In this case, early identification through imaging facilitated timely intervention. Flexible bronchoscopy is a preferred approach due to its minimally invasive nature, detailed visualization, and reduced recovery time compared to rigid bronchoscopy or surgical extraction. The snare technique allows for secure removal of nonimpacted foreign objects with minimal tissue injury (1). While complications from bronchoscopic removal can include bleeding, airway trauma, infection, or incomplete retrieval, careful technique and appropriate patient selection can minimize these risks.

This case underscores the importance of prompt imaging and bronchoscopic management in aspirated foreign bodies (2). The patient recovered without complication and was discharged following observation. The case also highlights successful endoscopic management of a dental screw aspirated into the right middle lobe and foreign body aspiration should be considered in patients who presents with cough after a dental procedure.

Azeberje Osueni MD, Aneesh Vasudevan MD, Ajeetha Priya Gajendiran MD, Grahish Arul and Kulothungan Gunasekaran MD

Pulmonary and Critical Care Medicine

Onvida Health

Yuma, Arizona USA

References

1. Khan J, Parmar M, Edwards L, Chaudray FW. Tooth in the lung: case report of a tooth aspirated during dental extraction [abstract]. Chest. 2022; 162(4):A2084.
2. Primera G, Matta J, Eubank L, Gurung P. The Lost Crown: A Case of an Aspirated Tooth Crown Causing Post-Obstructive Pneumonia. Case Rep Dent. 2023 Mar 8;2023:4863886. [CrossRef] [PubMed]

Cite as: Osueni A, Vasudevan A, Gajendiran AP, Arul G, Gunasekaran K. May 2025 Medical Image of the Month: Aspirated Dental Screw. Southwest J Pulm Crit Care Sleep. 2025;30(5):53-54. doi: https://doi.org/10.13175/swjpccs013-25 PDF