Doctors Catch Unusual Trigger for Breathing Disorder

Cleveland Clinic Abu Dhabi surgeons remove fish bone from patient’s lung, solving mystery of worsening condition

Doctors at Cleveland Clinic Abu Dhabi have solved the mystery of a young woman’s worsening respiratory condition by finding an unexpected clue in the patient’s lung.

What had initially been diagnosed as a worsening of the patient’s asthma before arriving at Cleveland Clinic Abu Dhabi was discovered to be caused by something very different – a fish bone.

The young Emirati patient was referred to Cleveland Clinic Abu Dhabi after visits to numerous other hospitals had failed to control her asthma-like symptoms, which were continually getting worse. Over the last six months she had become increasingly breathless and wheezy, and suffered from coughing fits during the night that were affecting her sleep and overall quality of life. 

“It was something of a mystery as to why the medications that had previously controlled the patient’s asthma had suddenly lost effectiveness,” said Dr. Ali Wahla, a pulmonologist at Cleveland Clinic Abu Dhabi. “It had got to the stage where the patient was unable to sleep. Rather than accept the prior diagnosis from other hospitals, we undertook a thorough examination to determine the cause of their symptoms.” 

The patient was admitted to the hospital’s Respiratory & Critical Care Institute where doctors approached the patient’s condition from a fresh perspective. It was during a chest CT scan that the cause of her symptoms came to light. Visible on the scan was a thin, hard body with a sharp end lodged in the patient’s lung, which doctors initially thought was a toothpick.

“The moment we saw the imaging of the patient’s lungs we realized her symptoms had been triggered by a foreign object lodged in her lung. It was quite dramatic, like unearthing an artifact – people rarely inhale large items without realizing,” says Dr. Wahla. 

Upon identifying the root cause of the symptoms, they performed a rigid bronchoscopy to examine the exact location of the item and ultimately identified it as a fish bone that had been there for months. 

“It was no wonder that the patient had been coughing and wheezing. Her lungs and airways were reacting to the presence of what was quite a large fish bone. The top priority then was to safely remove it as soon as possible,” continued Dr. Wahla. 

Specialists at Cleveland Clinic Abu Dhabi removed the bone from the patient’s lung during a second rigid bronchoscopy procedure, where they were able to grasp the fish bone with special forceps to remove it. 

“The task of removing the fish bone from the lung was both complex and high-risk due to the risk of bleeding and airway wall rupture,” said Dr. Wahla. 

Following the treatment, doctors at the hospital prescribed oral steroids and a nebulizer to decrease any inflammation in her airways as well as broad-spectrum antibiotics to ensure the bone didn’t cause an infection. 

After removing the fish bone, there was a dramatic decrease in the patient’s symptoms and she was able to stop taking a number of medications that had been prescribed to alleviate them. The fact that her worsening symptoms had been caused by a foreign object rather than a worsening of her asthma meant that she could continue to manage her asthma through medication and lifestyle changes without the need for more advanced treatments.

Cleveland Clinic Abu Dhabi’s Respiratory & Critical Care Institute provides comprehensive diagnosis and treatment of lung and breathing disorders for patients suffering from a range of respiratory conditions. The Institute has introduced several cutting-edge asthma treatments to the Middle East, including bronchial thermoplasty and innovative biological therapies.