Accidental aspiration of head scarf pin in left bronchus piercing the lung parenchyma: A rare case in a child.

Foreign body (FB) aspiration is commonly seen in children but less commonly in adolescents. Headscarf pin aspiration is common in Muslim girls, who inappropriately place the pins between their lips while securing the scarf on the head. Bronchoscopy is the treatment modality of choice, and surgery is rarely required. An 11-year-old girl was admitted as a case of accidental aspiration of headscarf pin. X-ray chest showed a radiopaque object in the left bronchus piercing the lung parenchyma. Computed tomography (CT) chest confirmed the diagnosis. The headscarf pin was removed by flexible bronchoscopy as the ear, nose, and throat (ENT) surgeon failed to remove it by rigid bronchoscopy. The FB was removed successfully and the patient was discharged home. Removal of a sharp pin by bronchoscopy is difficult, especially if it pierces the lung parenchyma. In our case, the pin was bent by forceps and then removed by a flexible bronchoscope, which requires a highly skilled professional.

INTRODUCTION

Foreign body (FB) aspiration is a common problem in young children. Frequently encountered FBs include coins, batteries, and magnets, but there is a distinct group of cases of Muslim children who wear headscarves inappropriately placing the safety pin in their mouth prior to securing the veil, leading to an accidental FB aspiration.[123] We report a classic case to highlight the presentation and management of such a FB.

CASE REPORT

An 11-year-old Muslim girl was admitted to our hospital due to accidental aspiration of a headscarf pin. She aspirated the pin while securing her scarf and holding the pin in the mouth. She was hemodynamically stable, and the systemic examination was unremarkable. Initial chest x-ray showed a sharp radiopaque object in the left bronchus piercing the lung parenchyma. Computed tomography (CT) chest was performed as requested by the thoracic surgeon for possible thoracotomy in case the bronchoscopy failed to remove the pin. CT chest confirmed the finding of x-ray chest [Figure 1].

Figure 1

CT chest showing sharp pin in left bronchus piercing the lung parenchyma

An ear, nose, and throat (ENT) surgeon failed to remove the pin by rigid bronchoscopy. A pediatric pulmonologist successfully removed the pin using flexible bronchoscopy, by bending the pin with forceps [Figures 2 and 3]. The repeat x-ray chest after the procedure was absolutely normal. The child did not have any complications after the procedure and was discharged home.

Figure 2

Endoscopic view of sharp pin piercing the lung parenchyma

Figure 3

Sharp pin was bent to remove it endoscopically

DISCUSSION

FB aspiration remains a common problem among young children. The nature of the FB varies according to region, age, food habits, and even clothing habits, but there is a common classification of organic and inorganic FB aspiration.[124] Organic materials such as nuts and seeds are the most commonly aspirated, while inorganic materials include a wide range of objects such as coins, plastic pieces, and toy parts. The younger age group is more vulnerable because of the lack of adequate dentition and immature swallowing coordination. In addition, among children of this age, introducing objects into their mouths is their way of exploring the world. Muslim girls wearing headscarves because of sociocultural and religious tradition sometimes accidentally aspirate a headscarf pin while holding the pin between their lips in order to secure the veil. Any maneuver then, such as laughter, talking, or coughing, predisposes them to aspiration, especially in the young teenage groups where they lack experience with such maneuvers.[123] This has been reported in the literature as “turban pin syndrome.”[56] In contrast to other forms of FB aspiration, headscarf pin aspirations tend to be easily diagnosed by x-ray chest as all of these inhaled FBs are radiopaque.[14] Complications of intrabronchial FB are obstructive emphysema, recurrent pneumopathy, bronchiectasis, pulmonary abscess, pleural effusion, and even pneumomediastinum.[789] Diagnostic bronchoscopy is rarely needed; rather, a therapeutic intervention is required. Rigid bronchoscopy is not successful, especially if the FB is distally located, hence flexible bronchoscopy is required in such cases. However, rigid bronchoscopy is preferred in children as it allows very efficient airway suctioning in case of massive bleed and is not time-consuming.[1011] Cases have been reported where distally located FBs were removed by fluoroscopically guided catheters in a cardiac catheterization lab.[12] Thoracotomy and bronchotomy are rarely required for the removal of FBs.[13] The aspiration hazard can be minimized by using adhesive bands or snap fasteners instead of pins when wearing a scarf.

CONCLUSION

Headscarf pin aspiration is common in Muslim girls, and the pins can usually be removed by flexible bronchoscopy. However, when the pin pierces the lung parenchyma, which is rare, it is necessary for a highly skilled pulmonologist to remove it endoscopically.

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Conflicts of interest

There are no conflicts of interest.