Pill aspiration: an under‐recognised clinical entity

Elliot T Bowden, Paul Smith and Karen M Dwyer
Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51337
Published online: 13 December 2021

An 85‐year‐old man with a history of type 2 diabetes, vascular disease and chronic kidney disease awoke with central sharp pleuritic pain radiating through to his back. He had been otherwise well leading up to this presentation. On examination, he had a temperature of 37.9°C, tachypnoea (respiratory rate, 25–30 breaths per minute), shallow breathing, and oxygen saturation of 88% on room air. Auscultation of his chest revealed vesicular breath sounds throughout both lung fields. Investigations showed a total white cell count of 16.6 × 109/L (reference interval, 4.0–11.0 × 109/L) and a C‐reactive protein level of 26 mg/L (reference interval, < 5mg/L). Chest x‐rays were unrevealing (Supporting Information). Differential diagnoses of pulmonary emboli, pulmonary sepsis and aortic dissection were considered. Computed tomography pulmonary angiography revealed a foreign body in the inferior portion of the right bronchus intermedius with the features of a pill (Box). On specific questioning, the patient reported having difficulties swallowing metformin the previous night, which was part of his therapeutic regimen for diabetes, although he did not report choking or coughing. Unfortunately, the patient suffered an unrelated fatal stroke before undergoing his planned bronchoscopy.

  • 1 Barwon Health, University Hospital Geelong, Geelong, VIC
  • 2 Epworth Medical Imaging, Geelong, VIC
  • 3 Deakin University, Geelong, VIC

Competing interests:

No relevant disclosures.

  • 1. Mehta AC, Khemasuwan D. A foreign body of a different kind: pill aspiration. Ann Thorac Med 2014; 9: 1–2.
  • 2. Mickelson J, O’Shea Paudel EE, Oliveira PJ. Pill aspiration: metformin induced bronchial stenosis masquerading as asthma. Am J Resp Crit Care Med 2019; 199: A4685.
  • 3. Küpeli E, Khemasuwan D, Lee P, Mehta AC. “Pills” and the air passages. Chest 2013; 144: 651–660.
  • 4. Kinsey CM, Folch E, Majid A, Channick CL. Evaluation and management of pill aspiration: case discussion and review of the literature. Chest 2013; 143: 1791–1795.
  • 5. Hewlett JC, Rickman OB, Lentz RJ, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis 2017; 9: 3398–3409.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.