Treatment of extensive endobronchial granulation tissue with cryotherapy and coagulation after foreign body aspiration: A case report

Introduction: Aspiration of foreign bodies is relatively uncommon in adults but may cause significant morbidity because of the formation of granulation tissue. This granulation tissue can cause complications, for example, airway obstruction, hemoptysis, and post-obstructive infections. Case Report: We present the case of a 63-year-old man with dyspnoea and hemoptysis. Computed tomography (CT) thorax showed a foreign body in the bronchus intermedius. Upon removal of the foreign body, extensive granulation tissue was found, causing bronchial obstruction. The granulation tissue was successfully treated with cryotherapy and coagulation. After cryotherapy, the patient was admitted because of a post-obstructive pneumonia caused by airway obstruction due to necrotic tissue. This necrotic tissue was removed during repeat bronchoscopy. Conclusion: Granulation tissue should only be removed when bronchial obstruction occurs. A stepwise approach is advised after removal of a foreign body when residual granulation tissue is present. Our case highlights this stepwise approach of conservative management with active follow-up. When bronchial obstruction is present, the granulation tissue should be removed. Interventional techniques such as cryotherapy or coagulation are effective. Cryotherapy causes necrotic tissue that will heal over time. However, this necrotic tissue can cause airway obstruction which can lead to post-obstructive pneumonia. This is a known delayed complication of cryotherapy and needs immediate re-intervention to clear the airways. Our case highlights the potential delayed complication of cryotherapy as well.