CHEST: Toy Vampire's Tooth Keeps Pulmonologists in the Dark

SALT LAKE CITY, Oct. 27 -- For eight years a toy vampire's tooth was lodged invisibly in a man's lung, the unwelcome souvenir of a long-ago Halloween party, before a pulmonologist's persistence, trying to solve a mysterious cough, brought the object to light.

Removing the foreign object from the lung of a 27-year-old man, which was accomplished bronchoscopically, proved to be easier than learning of its existence.

The tooth had been aspirated during a Halloween party eight years earlier, and emergency physicians at the time determined it had been ingested. The patient did not connect his unexplained chronic cough with the incident.

"Something about this case didn't add up," said Antonio Salud II, M.D., a pulmonary fellow at the University of Utah here, who discussed it at CHEST 2006, the meeting of the American College of Chest Physicians.

The man recalled a bout of pneumonia five years earlier that pre-dated the chronic cough, but Dr. Salud didn't think that was the problem.

The patient was not on medication, and he denied the use of tobacco, alcohol, or illicit drugs. He had no significant travel history and he had no occupational contact with chemicals, dust, asbestos or exotic pets.

The patient had reported a four-year history of episodic sputum production, hemoptysis and shortness of breath several times per month, Yet Dr. Salud performed lung function tests without finding anything amiss. The chest exam was normal, and the man had normal vital signs. Yet he continued to cough.

"So I kept asking the patient more and more questions," Dr. Salud said. "Eventually, he remembered swallowing the tooth."

A CT exam revealed a right lower lobe volume loss with variable bronchiectasis and hyperlucent material in a basilar segment.

Flexible bronchoscopy revealed granulation tissue occluding the right lower lobe bronchus. Rigid bronchoscopy, performed that day, revealed the edge of a foreign body that was removed with a forceps. The foreign body was a V-shaped plastic tooth approximately 1.5 cm at its base.

According to the patient's Halloween tale, he had worn a vampire costume to the party. He recalled that after he aspirated the tooth, he sought treatment at an emergency room. Doctors there found no evidence of the tooth and suggested that it had been ingested rather than aspirated. That was the last time the man had thought about the tooth until his visit to Dr. Salud.

Once the foreign body was retrieved, the patient recovered without incident. Dr. Salud said the man refused further treatment or follow-up visits because he felt fine.

"Being a pulmonologist is like being a medical detective," commented Diane Stover, M.D., chief of the pulmonary service and at the Memorial Sloan-Kettering Cancer Center in New York. "This vampire case shows again how important it is for physicians to take the time to do a careful patient history."