The male patient, now 50 years old, reported that throughout his childhood, he regularly played with, and swallowed, Playmobil toy pieces. On his seventh birthday, back in 1974, he received a Playmobil set, and recalled swallowing the toy cone shortly afterward.
At 46 years old, the patient consulted a doctor about a chronic cough that was concerning him. During his first couple months of treatment, he was diagnosed with pneumonia, thickening and stiffness in the right lung, and bronchiectasis, or damage of the breathing tubes. This all meant less air was entering his lungs.
When the patient finally reached Munavvar’s clinic at the age of 47, they ran multiple tests, including a CAT scan, and conducted a white light bronchoscopy, a procedure involving the insertion of a scope inside the airways to view the lungs. The doctor noticed extensive shadowing and a thickening lump in the lower right lung.
These symptoms, along with the spread of a bacterial infection in the pockets of the lower right lung, led his team to believe that the man had a tumor, which needed prompt removal.
“We acted quickly because a bacterial infection could spread to other regions outside of the lungs,” said Munavvar.
The patient underwent surgery, and only after removing the mass was it identified as a Playmobil toy cone that “had been absorbed into the mucosal lining of the bronchial (air passage) which developed around it,” explained the case report.
His airway “was able to remodel and adapt to the presence of this foreign body,” which is most likely why he did not show symptoms until he was 40, the report said.
Another reason that the cone may have gone unnoticed over time is that it was made of harmless plastic, Munavvar said. He also noted that severe consequences could have developed if the toy cone continued to go unnoticed by doctors. If the airway remained blocked, there would be an increased risk for harsher infections, pneumonia and scarring of the lungs, all of which could contribute to respiratory failure.
The patient also had a long history of smoking, but doctors did not contribute this factor as a possible cause of the infectious symptoms, said Munavvar.
Four months after the toy was removed from the patient, his cough had almost disappeared and X-rays showed only a minor residual lung infection and irritation, said the report.
When a toy goes down a person’s breathing tube — known as tracheobronchial foreign body aspiration — this is often diagnosed after a week or so, but 1% to 5% of children go undiagnosed for for longer periods of time due to various reasons, including normal examinations and chest X-rays and misdiagnosis, according to the case consultants.
In adults, detection can take much longer, yet only three cases have ever gone undetected for more than 20 years, according to the report.
When to seek help
When a child or adult swallows a foreign object, such as peanuts, bobby pins, screws, braces wires or toys, the majority of the time it will be excreted naturally.
But “going down breathing tubes is uncommon, it is actually rare,” Munavvar noted.
However, it is possible that individuals, usually young children, can choke on many foreign objects, causing the them to enter the lung cavity.
“If the child chokes on (an) object and develops a chronic cough, that’s when you should worry.”
Children may not be able to give accurate descriptions of what happened before the cough, nor the symptoms that developed, so it is safest for parents to seek immediate medical attention, said Munavvar.
Common symptoms that mimic TFB in children include irritation of the airway, asthma, pneumonia and excess production of mucous. In adults, the syndrome mimics bronchogenic carcinomas, and although difficult to diagnose, Munavvar noted that chronic coughing is a strong indicator of a possible irregularity in the lungs.
The most important sign of TFB for any adult or child is if they choke on an object and develop chronic coughing. If an adult has a chronic cough but does not recall choking, the symptom is most likely related to something else, said Munavvar.