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The case of the hidden rupee
1 PhD Candidate, Department of Anatomy, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
2 Resident Physician, Department of Otolaryngology – Facial Plastic Surgery, Henry Ford Macomb Hospital, Clinton Township, MI, USA
3 Dean, School of Graduate Studies, Department of Anatomy, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
Address correspondence to:
Randy Kulesza
PhD, Department of Anatomy, Lake Erie College of Osteopathic Medicine, 1858 West Grandview Blvd, Erie, PA 16509,
USA
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Article ID: 100003Z18YM2021
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Mansour Y, Kulesza R. The case of the hidden rupee. J Case Rep Images Otolaryngol 2021;2(1):100003Z18YM2021.ABSTRACT
No Abstract
Keywords: Foreign body, Larynx, Pharynx
Case Report
A 60-year-old cachectic male presented to the anatomy lab at the Lake Erie College of Osteopathic Medicine for post-mortem dissection in the medical gross anatomy course. Examination of the man’s neck revealed a fresh cricothyrotomy incision (Figure 1A). His cause of death was listed as natural death, failure to thrive, severe general debility, severe generalized atherosclerosis, and coronary artery disease. During dissection of the pharynx via posterior approach, a foreign body was identified in his laryngopharynx that caused leftward deviation of his larynx (Figure 1B, arrowhead). There was evidence of hemorrhage in his esophagus (Figure 1B, white arrowhead). Closer inspection revealed the foreign body to be a 1928 ¼ rupee coin tightly lodged in his right piriform recess [Figure 1C (arrowhead) and Figure 1D]. The coin measured 1.85 cm in diameter. Inspection of his trachea and lungs revealed an abundant soapy discharge.
Discussion
The incidence of foreign body aspiration is only 0.66 per 100,000 in the United States [1] and is more common in children but can occur in any age group including elderly [2],[3]. In fact, adults comprise only 25% of cases [1] and aspirated foreign bodies are successfully removed in over 91% of cases [4]. Airway foreign objects can range from the classic fishbone to insects or dentures [2],[5] Lodging of foreign object in the airway can impair breathing and result in acute respiratory distress [6]. The piriform recess is a common site for aspirated foreign objects to become lodged and objects lodged in this location can compress the larynx, impair breathing, and may be fatal. In cases of respiratory distress, quick identification and removal of the foreign body is essential. Recognizing an aspiration is more easily achieved if the patient can tell the care-team that they swallowed something or if there was a witness to the event. However, presentation of cachectic patient in respiratory distress, an aspirated foreign object may not be high on the differential diagnosis.
Conclusion
Aspirated foreign objects range widely in size and shape. Even relatively small objects lodged in the piriform recess can be fatal, especially, in young children and the elderly.
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SUPPORTING INFORMATION
Acknowledgments
The authors would like to thank the donor and his family for his donation to anatomy education and medical research.
Author ContributionsYusra Mansour - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Randy Kulesza - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Yusra Mansour et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
