Endobronchial Cocaine Packet Aspiration Managed via Flexible Bronchoscopy

In this report, we discuss the case of a 55-year-old male, who presented to Accident & Emergency with worsening shortness of breath. This gentleman is a known case of Chronic Obstructive Pulmonary Disease (COPD) and is a regular cocaine and heroin user. During the admission, he was noted to have persistent hypoxia despite being managed as a COPD exacerbation. His chest x-ray was normal, and further investigation with CT pulmonary angiography identified a left sided 12 mm × 9 mm × 12 mm dense area at the level of bifurcation of the left main bronchus, suspicious of a foreign body aspiration. Flexible bronchoscopy revealed a cocaine packet made of aluminium foil and his symptoms resolved upon removal. To our knowledge this is one of the few encountered cases where aspiration of cocaine packets has occurred. This case highlights the need for a high index of suspicion in patients with a history of substance use who present with acute respiratory symptoms.