Masafumi Fukuda1, Masakazu Nabeta2, Hideaki Uzu2, Osamu Takasu2. 1. Advanced Emergency and Critical Care Center Kurume University Hospital Kurume Fukuoka Japan. 2. Advanced Emergency and Critical Care Center Kurume University Hospital Department of Emergency and Acute Intensive Care Medicine Kurume University School of Medicine Kurume Fukuoka Japan.
We report the case of an 83‐year‐old male who choked while eating and was transferred to an emergency department in a state of cardiac arrest. Cardiopulmonary resuscitation was successfully performed immediately after removing the foreign body obstructing the airway under direct vision. However, because of insufficient dilation of the right thorax during ventilation after tracheal intubation along with reduced respiratory sounds, a computed tomography (CT) imaging test was performed. Carrying out assisted ventilation using an endotracheal tube restricted the respiratory expansion of the right thorax and diminished the breath sounds on the same side.
DIAGNOSIS
Foreign body airway obstruction. Figures 1 and 2 present the chest CT images of the patient. The foreign body obstructing the airway was a rice cake called mochi. Mochi is a traditional Japanese rice cake made by steaming and kneading glutinous rice (Figure 3), which can easily adhere to the pharynx and trachea, making it a common cause of choking among older adults in Japan.
It was detected as a nearly uniform high‐density object on CT; its CT Hounsfield unit (HU, 120–170 HU) indicates a characteristic value among foods.
Therefore, distinguishing mochi from other foodstuff is possible.
FIGURE 1
Chest computed tomography image at the tracheal bifurcation level. The trachea was about to be obstructed by mochi (red arrow)
FIGURE 2
Chest computed tomography image at the main bronchi level. The bronchus principalis dexter was about to be obstructed by mochi (red arrow)
FIGURE 3
Traditional Japanese rice cake, called mochi, made by steaming and kneading glutinous rice
Chest computed tomography image at the tracheal bifurcation level. The trachea was about to be obstructed by mochi (red arrow)Chest computed tomography image at the main bronchi level. The bronchus principalis dexter was about to be obstructed by mochi (red arrow)Traditional Japanese rice cake, called mochi, made by steaming and kneading glutinous riceBecause it is not possible to remove mochi from below the glottis either with or without direct vision, a bronchoscope is used in the ED if CT shows that the mochi remains under the glottis. As rapid warming makes mochi sticky, dragging it by suction or forceps is often extremely challenging. Thus, a strategic approach, such as using multiprong snares or baskets,
is especially important when removing a foreign body obstructing the airway.Foreign body airway obstruction is a serious public health problem worldwide. Because Japanese food has recently become globally recognized, CT findings linking to a definitive diagnosis of specific foods are believed to be crucial.
FIGURE 1
FIGURE 2
FIGURE 3