Karadimou K, Mavrovounis G, Karapetsa M, Pantazopoulos I. Aspiration of a metallic-crowned tooth in the left main bronchus in a neurocritical patient: A case report. World J Clin Cases 2026; 14(21): 120561 [DOI: 10.12998/wjcc.120561]
Corresponding Author of This Article
Ioannis Pantazopoulos, Department of Emergency Medicine, University of Thessaly, Mezourlo, Larissa 41334, Greece. pantazopoulosioannis@yahoo.com
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Respiratory System
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case-report
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Karadimou K, Mavrovounis G, Karapetsa M, Pantazopoulos I. Aspiration of a metallic-crowned tooth in the left main bronchus in a neurocritical patient: A case report. World J Clin Cases 2026; 14(21): 120561 [DOI: 10.12998/wjcc.120561]
World J Clin Cases. Jul 26, 2026; 14(21): 120561 Published online Jul 26, 2026. doi: 10.12998/wjcc.120561
Aspiration of a metallic-crowned tooth in the left main bronchus in a neurocritical patient: A case report
Konstantina Karadimou, Georgios Mavrovounis, Maria Karapetsa, Ioannis Pantazopoulos
Konstantina Karadimou, Ioannis Pantazopoulos, Department of Respiratory Medicine, University of Thessaly, Larisa 41334, Thessalía, Greece
Georgios Mavrovounis, Ioannis Pantazopoulos, Department of Emergency Medicine, University of Thessaly, Larissa 41334, Greece
Maria Karapetsa, Department of Intensive Care, University of Thessaly, Larisa 41334, Thessalía, Greece
Author contributions: Karadimou K and Mavrovounis G contributed to conceptualization; Karadimou K contributed to data collection, literature review, and drafting of the manuscript; Mavrovounis G and Pantazopoulos I contributed to supervision; Karadimou K and Pantazopoulos I contributed to bronchoscopic management of the case; Mavrovounis G, Karapetsa M, and Pantazopoulos I contributed to critical revision of the manuscript for important intellectual content; Karapetsa M contributed to clinical management in the intensive care unit and data acquisition; Pantazopoulos I contributed to study design, final approval of the version to be published. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: AI was not used at any stage of the preparation of this manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Ioannis Pantazopoulos, Department of Emergency Medicine, University of Thessaly, Mezourlo, Larissa 41334, Greece. pantazopoulosioannis@yahoo.com
Received: March 3, 2026 Revised: May 22, 2026 Accepted: June 16, 2026 Published online: July 26, 2026 Processing time: 140 Days and 21.7 Hours
Abstract
BACKGROUND
Aspiration of dental elements in adults is an uncommon but clinically significant event, which is typically associated with iatrogenic airway manipulation or impaired airway protective reflexes. The right main bronchus is the most common site of foreign-body aspiration, while left-sided aspiration is less common. Dental crowns containing metallic components are usually easily identifiable on imaging because of their radiopacity. However, they may also generate artifacts that complicate accurate radiological interpretation.
CASE SUMMARY
We present the case of a 71-year-old neurocritical care patient with a large left thalamic intracerebral hemorrhage of unknown etiology and a previous history of pulmonary hydatid cyst. The patient aspirated a natural tooth with a metallic crown following tracheostomy. Initially, there was no suspicion of dental loss or aspiration and the foreign body was incidentally identified on routine post-procedural imaging one day after the tracheostomy. A dense radiopaque endobronchial object in the left main bronchus was identified on computed tomography. Beam-hardening artifacts limited immediate identification. Flexible bronchoscopy confirmed the diagnosis and allowed safe removal using tripod forceps.
CONCLUSION
This case highlights that even radiopaque foreign bodies may remain clinically unsuspected, particularly in neurocritical care patients. Aspiration into atypical anatomical locations such as the left main bronchus should be considered. Early bronchoscopy is an essential tool in the diagnosis and management of such cases.
Core Tip: Aspiration of dental crowns in adults is rare and frequently occurs in patients with impaired consciousness or following airway manipulation. Despite their radiopacity, metallic crowns may be misinterpreted on imaging. This case emphasizes the importance of maintaining diagnostic vigilance for foreign-body aspiration in atypical anatomical locations and highlights the role of early bronchoscopy in these patients.
