Tracheostomy Care Gone Awry: A Rare Cause of Empyema

Tracheostomy Care Gone Awry: A Rare Cause of Empyema | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Tracheostomy Care Gone Awry: A Rare Cause of Empyema Dhwani Patel, Kriti Y C, Anuj Kumar, Nitin Shetty This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7111513/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract In patients with cancer, unilateral pleural effusion is typically due to malignancy or infection. Foreign body (FB) aspiration is a rare and often missed cause, particularly in patients with Tracheostomy. We report the case of a 57-year-old man who underwent chemoradiotherapy for tongue cancer and developed empyema secondary to a retained tracheostomy brush fragment. The foreign body was identified via imaging and bronchoscopy and successfully removed, with full recovery following antibiotics and drainage. This case highlights the need for clinical vigilance, proper tracheostomy care, and safe device design to prevent such avoidable complications. Figures Figure 1 Figure 2 Introduction Unilateral pleural effusion, with over 50 potential causes documented in the literature, often presents a diagnostic challenge for clinicians. In patients with cancer, it often results from malignant pleural effusion due to metastatic spread or direct pleural invasion by tumors. Other causes can include paramalignant effusions, related to infections secondary to collapse or immunosuppression, inflammatory responses to chemotherapy or radiation, and conditions like atelectasis or pulmonary thromboembolism (1). This case highlights an uncommon etiology: a chronic, non-asphyxiated FB lodged in the lungs leading to unilateral loculated pleural effusion. Diagnosing FB aspiration is particularly challenging without a clear history because symptoms such as cough and dyspnea are nonspecific. Chronic FB aspiration can cause complications, such as atelectasis, recurrent pneumonia, and bronchial stenosis (2). Case Report A 57-year-old male with a history of cancer of the base of the tongue who was treated a year earlier with definitive chemoradiotherapy and a tracheostomy for stridor presented with right-sided chest pain, progressive breathlessness, productive cough, fever, and yellow secretions from his tracheostomy tube for 3 weeks. He recalled that a tracheostomy cleaning brush had broken during care three months prior, but he thought it had passed through his gastrointestinal tract, leading to no further action. On examination, tachycardia, low-grade fever, hypoxia (resting oxygen saturation of 94%), grade 3 finger clubbing, and diminished breath sounds in the lower right hemithorax were noted. Investigations revealed leukocytosis, elevated CRP levels, and normocytic normochromic anemia. A chest radiograph and contrast-enhanced CT scan demonstrated a right-sided loculated pleural effusion and a radiopaque foreign body (FB) in the right lower lobe (Figure 1A). The patient was started on antibiotics (piperacillin-tazobactam and ciprofloxacin). An image-guided pleural drain was placed and to stabilise the patient, purulent pleural fluid aspirated was sent for analysis. Bronchoscopy was performed via the tracheostomy tube (size 8.0mm), with the cuff deflated, revealing a metallic FB, a broken tracheostomy cleaning brush lodged in the anterior segment of the right lower lobe bronchus, with its tip extending into the right lower lobe bronchus and associated inflamed mucosa. Bronchoscopy also revealed >50% stenosis in the right middle lobe bronchus. The FB was successfully removed in its entirety using forceps, and the purulent secretions were evacuated during the procedure (Fig 1C). Follow up bronchoscopy showed no remnants of the FB. BAL fluid cultures on follow up showed the growth of Pseudomonas aeruginosa and Serratia marcescens .. Pleural fluid analysis was negative for bacterial growth, tuberculosis, and malignancy. Patient was discharged after a week of IV antibiotics, antibiotics were continued for 6 weeks in total. Follow-up chest radiographs after six weeks showed significant improvement with residual pleural thickening(Figure 1B). Discussion FBA is a rare but significant cause of unilateral pleural effusion in patients with cancer, in whom malignancy-related processes often dominate clinical suspicion(1). Patients who are tracheotomized are particularly vulnerable to bypassing the natural upper airway protective mechanisms(3). Aspirational events may go unrecognized without a clear history. Metallic foreign bodies, as they are radio-opaque, are likely to be picked during imaging, while organic foreign bodies may be missed. Enhanced patient and caregiver education regarding tracheostomy maintenance and red-flag signs is critical(4). Furthermore, design improvements in cleaning devices, such as single-use brushes, break-resistant materials, and visual safety markers, may mitigate the risk of device fragmentation and aspiration. Chronic FB retention leads to persistent inflammation, complications such as bronchial stenosis(2), and severe conditions like empyema(5), as observed in this case. Timely Bronchoscopic removal and appropriate antibiotic therapy, remain the cornerstone of treatment(6). However, the diagnostic delay in this instance underscores the need for increased clinical vigilance in similar cases. Clinicoradiological follow-up is crucial because the possibility of concomitant malignancy recurrence should not be overlooked. Conclusion This case highlights the diagnostic and therapeutic challenges associated with FBA in patients with tracheostomy and cancer. This emphasizes the importance of meticulous tracheostomy care, thorough radiological evaluation, and timely bronchoscopy ( 3 , 7 ) to ensure early intervention and reduced morbidity. Additionally, design modifications for tracheostomy cleaning implements should be considered to prevent such incidents. Abbreviations a. FB Foreign Body b. CT Computed Tomography Declarations Ethics approval and consent to participate: This case report is retrospective and uses anonymized patient data. Confidentiality will be rigorously maintained. Patient Consent for publication : Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the consent form uploaded as related file is available for review by the Editor of this journal. Availability of data and materials: Yes All data generated or analysed during this study are included in this published article. Any additional datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: None Funding: None Authors’ contributions Kriti YC: case management, conceptualized case report, draft editing, preparation of final manuscript. Dhwani Patel: case management, prepared initial draft, and figures. Anuj Kumar: case management, revised and edited manuscript. Nitin Shetty: case management, review of figures and figure legends, draft editing. All authors reviewed the manuscript. Acknowledgements: None References Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002;346(25):1971–7. Rodrigues AJ, Oliveira EQ, Scordamaglio PR, Gregório MG, Jacomelli M, Figueiredo VR. Bronchoscopy for foreign body removal: experience of a Brazilian referral center. J Bras Pneumol. 2012;38(1):41–7. Eliçora A, Sezer HF, Abdullayev G, Avcı A, Topçu S. Accidental Foreign Body Aspiration Through Tracheostomy Inlet; 26 cases. Arch Iran Med. 2022;25(5):308–13. 10.34172/aim.2022.50 . PMID: 35943006; PMCID: PMC11904291. Donado JR, Paz IG, Zadikian JH, Villamizar N. Tracheobronchial foreign bodies in adults: Risk factors, complications, and management. J Bronchol Interv Pulmonol. 2016;23(4):315–22. Hsu AA, Tan KT, Tan P, Chiang M, Lee E. Bronchoscopic removal of airway foreign body: an experience with 118 cases in a regional hospital. Singap Med J. 2015;56(3):e51–6. Davies HE, Davies RJ, Davies CW, BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii41–53. Shankar KR, Losty PD, Hopper M, Jones MO, Howard R. Tracheobronchial foreign body: an analysis of morbidity, mortality and surgical management. Eur J Pediatr Surg. 2014;24(2):150–3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Sep, 2025 Reviews received at journal 14 Sep, 2025 Reviewers agreed at journal 14 Sep, 2025 Reviews received at journal 13 Sep, 2025 Reviews received at journal 13 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviews received at journal 11 Sep, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviewers agreed at journal 07 Sep, 2025 Reviewers agreed at journal 04 Sep, 2025 Reviewers invited by journal 04 Sep, 2025 Editor invited by journal 14 Aug, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 11 Aug, 2025 First submitted to journal 11 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7111513","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":511487183,"identity":"4cd409ed-9022-4d60-9ca3-2fb8e5f519d4","order_by":0,"name":"Dhwani Patel","email":"","orcid":"","institution":"Advanced Centre for Treatment, Research and Education in Cancer","correspondingAuthor":false,"prefix":"","firstName":"Dhwani","middleName":"","lastName":"Patel","suffix":""},{"id":511487184,"identity":"25e5ed35-8a38-44f3-92b0-3a5958bfb5d5","order_by":1,"name":"Kriti Y C","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBACCQbGBoYEBgY5EOfAAyK1NDYAtRiDtSQQpwVkDQNDIohgIEqL5OzD7Q8ettmlzw87/BBoi52cbgMBLdJ8iY0NiW3JuRtvpxkAtSQbmx0goEWOhxGk5UDuxtkJIC0HErcRqyXdcHb6B+K0SEO1JMhL5xBpi2QPY+OMhHPJhhukcwoOJBgQ4ReJM+wPPv4os5OXn52++cOHCjs5glrAgJGNgcEArNKAGOVg8IeBQb6BaNWjYBSMglEw0gAAo8tHigQ0OewAAAAASUVORK5CYII=","orcid":"","institution":"Advanced Centre for Treatment, Research and Education in Cancer","correspondingAuthor":true,"prefix":"","firstName":"Kriti","middleName":"Y","lastName":"C","suffix":""},{"id":511487185,"identity":"5c68f2cb-133a-4b72-835d-24d1e6d9a8ca","order_by":2,"name":"Anuj Kumar","email":"","orcid":"","institution":"Advanced Centre for Treatment, Research and Education in Cancer","correspondingAuthor":false,"prefix":"","firstName":"Anuj","middleName":"","lastName":"Kumar","suffix":""},{"id":511487186,"identity":"8e5707ec-8b3b-4c12-b9bb-f8cd15c5d7ce","order_by":3,"name":"Nitin Shetty","email":"","orcid":"","institution":"Advanced Centre for Treatment, Research and Education in Cancer","correspondingAuthor":false,"prefix":"","firstName":"Nitin","middleName":"","lastName":"Shetty","suffix":""}],"badges":[],"createdAt":"2025-07-13 06:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7111513/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7111513/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91192219,"identity":"033ee795-ce20-417e-a8f7-ef877a72d039","added_by":"auto","created_at":"2025-09-12 14:41:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":208893,"visible":true,"origin":"","legend":"\u003cp\u003eChest X-ray and CT thorax on presentation (A) and treatment completion (B)\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7111513/v1/75d299bc781ad99f552fc11a.jpg"},{"id":91190040,"identity":"7416a16f-5a9a-4a97-af95-3edfa1bc1bee","added_by":"auto","created_at":"2025-09-12 14:33:59","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29197,"visible":true,"origin":"","legend":"\u003cp\u003eForeign body extracted from Right lower lobe anterior segment.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7111513/v1/68a0b44971f41381b728a9e8.jpg"},{"id":91192319,"identity":"3fa1b1e4-f57f-4846-aade-88e8163c9e72","added_by":"auto","created_at":"2025-09-12 14:42:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":447489,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7111513/v1/5b70be1d-2e2c-4c47-a5ca-ff7bf1a004f4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Tracheostomy Care Gone Awry: A Rare Cause of Empyema","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUnilateral pleural effusion, with over 50 potential causes documented in the literature, often presents a diagnostic challenge for clinicians. In patients with cancer, it often results from malignant pleural effusion due to metastatic spread or direct pleural invasion by tumors. Other causes can include paramalignant effusions, related to infections secondary to collapse or immunosuppression, inflammatory responses to chemotherapy or radiation, and conditions like atelectasis or pulmonary thromboembolism (1).\u003c/p\u003e\n\u003cp\u003eThis case highlights an uncommon etiology: a chronic, non-asphyxiated FB lodged in the lungs leading to unilateral loculated pleural effusion. Diagnosing FB aspiration is particularly challenging without a clear history because symptoms such as cough and dyspnea are nonspecific. Chronic FB aspiration can cause complications, such as atelectasis, recurrent pneumonia, and bronchial stenosis (2).\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 57-year-old male with a history of cancer of the base of the tongue who was treated a year earlier with definitive chemoradiotherapy and a tracheostomy for stridor presented with right-sided chest pain, progressive breathlessness, productive cough, fever, and yellow secretions from his tracheostomy tube for 3 weeks. He recalled that a tracheostomy cleaning brush had broken during care three months prior, but he thought it had passed through his gastrointestinal tract, leading to no further action.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn examination, tachycardia, low-grade fever, hypoxia (resting oxygen saturation of 94%), grade 3 finger clubbing, and diminished breath sounds in the lower right hemithorax were noted.\u003c/p\u003e\n\u003cp\u003eInvestigations revealed leukocytosis, elevated CRP levels, and normocytic normochromic anemia. A chest radiograph and contrast-enhanced CT scan demonstrated a right-sided loculated pleural effusion and a radiopaque foreign body (FB) in the right lower lobe (Figure 1A).\u003c/p\u003e\n\u003cp\u003eThe patient was started on antibiotics (piperacillin-tazobactam and ciprofloxacin). An image-guided pleural drain was placed and to stabilise the patient, purulent pleural fluid aspirated was sent for analysis. Bronchoscopy was performed via the tracheostomy tube (size 8.0mm), with the cuff deflated, revealing a metallic FB, a broken tracheostomy cleaning brush lodged in the anterior segment of the right lower lobe bronchus, with its tip extending into the right lower lobe bronchus and associated inflamed mucosa. Bronchoscopy also revealed \u0026gt;50% stenosis in the right middle lobe bronchus. The FB was successfully removed in its entirety using forceps, and the purulent secretions were evacuated during the procedure (Fig 1C). Follow up bronchoscopy showed no remnants of the FB.\u003c/p\u003e\n\u003cp\u003eBAL fluid cultures on follow up showed the growth of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and \u003cem\u003eSerratia marcescens\u003c/em\u003e.. Pleural fluid analysis was negative for bacterial growth, tuberculosis, and \u0026nbsp;malignancy. Patient was discharged after a week of IV antibiotics, antibiotics were continued for 6 weeks in total. Follow-up chest radiographs after six weeks showed significant improvement with residual pleural thickening(Figure 1B).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFBA is a rare but significant cause of unilateral pleural effusion in patients with cancer, in whom malignancy-related processes often dominate clinical suspicion(1). Patients who are tracheotomized are particularly vulnerable to bypassing the natural upper airway protective mechanisms(3). Aspirational events may go unrecognized without a clear history. Metallic foreign bodies, as they are radio-opaque, are likely to be picked during imaging, while organic foreign bodies may be missed. Enhanced patient and caregiver education regarding tracheostomy maintenance and red-flag signs is critical(4). Furthermore, design improvements in cleaning devices, such as single-use brushes, break-resistant materials, and visual safety markers, may mitigate the risk of device fragmentation and aspiration. Chronic FB retention leads to persistent inflammation, complications such as bronchial stenosis(2), and severe conditions like empyema(5), as observed in this case.\u003c/p\u003e\n\u003cp\u003eTimely Bronchoscopic removal and appropriate antibiotic therapy, remain the cornerstone of treatment(6). However, the diagnostic delay in this instance underscores the need for increased clinical vigilance in similar cases. Clinicoradiological follow-up is crucial because the possibility of concomitant malignancy recurrence should not be overlooked.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the diagnostic and therapeutic challenges associated with FBA in patients with tracheostomy and cancer. This emphasizes the importance of meticulous tracheostomy care, thorough radiological evaluation, and timely bronchoscopy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) to ensure early intervention and reduced morbidity. Additionally, design modifications for tracheostomy cleaning implements should be considered to prevent such incidents.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ea. FB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eForeign Body\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eb. CT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: This case report is retrospective and uses anonymized patient data. Confidentiality will be rigorously maintained.\u003c/p\u003e\n\u003cp\u003ePatient Consent for publication :\u0026nbsp;Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the consent form\u0026nbsp;uploaded as related file\u0026nbsp;is available for review by the Editor of this journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Yes\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article. Any additional\u0026nbsp;datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: None\u003c/p\u003e\n\u003cp\u003eFunding: None\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eKriti YC: case management, conceptualized case report, draft editing, preparation of final manuscript.\u003c/p\u003e\n\u003cp\u003eDhwani Patel: \u0026nbsp;case management, prepared initial draft, and figures.\u003c/p\u003e\n\u003cp\u003eAnuj Kumar: \u0026nbsp;case management, revised and edited manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNitin Shetty: case management, review of figures and figure legends, draft editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLight RW. Clinical practice. Pleural effusion. N Engl J Med. 2002;346(25):1971\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodrigues AJ, Oliveira EQ, Scordamaglio PR, Greg\u0026oacute;rio MG, Jacomelli M, Figueiredo VR. Bronchoscopy for foreign body removal: experience of a Brazilian referral center. J Bras Pneumol. 2012;38(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEli\u0026ccedil;ora A, Sezer HF, Abdullayev G, Avcı A, Top\u0026ccedil;u S. Accidental Foreign Body Aspiration Through Tracheostomy Inlet; 26 cases. Arch Iran Med. 2022;25(5):308\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.34172/aim.2022.50\u003c/span\u003e\u003cspan address=\"10.34172/aim.2022.50\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35943006; PMCID: PMC11904291.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDonado JR, Paz IG, Zadikian JH, Villamizar N. Tracheobronchial foreign bodies in adults: Risk factors, complications, and management. J Bronchol Interv Pulmonol. 2016;23(4):315\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHsu AA, Tan KT, Tan P, Chiang M, Lee E. Bronchoscopic removal of airway foreign body: an experience with 118 cases in a regional hospital. Singap Med J. 2015;56(3):e51\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavies HE, Davies RJ, Davies CW, BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii41\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShankar KR, Losty PD, Hopper M, Jones MO, Howard R. Tracheobronchial foreign body: an analysis of morbidity, mortality and surgical management. Eur J Pediatr Surg. 2014;24(2):150\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7111513/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7111513/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn patients with cancer, unilateral pleural effusion is typically due to malignancy or infection. Foreign body (FB) aspiration is a rare and often missed cause, particularly in patients with Tracheostomy. We report the case of a 57-year-old man who underwent chemoradiotherapy for tongue cancer and developed empyema secondary to a retained tracheostomy brush fragment. The foreign body was identified via imaging and bronchoscopy and successfully removed, with full recovery following antibiotics and drainage. This case highlights the need for clinical vigilance, proper tracheostomy care, and safe device design to prevent such avoidable complications.\u003c/p\u003e","manuscriptTitle":"Tracheostomy Care Gone Awry: A Rare Cause of Empyema","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 14:25:54","doi":"10.21203/rs.3.rs-7111513/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-30T12:52:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T22:27:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53690665487930868139395802710940565818","date":"2025-09-14T22:19:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-13T14:56:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-13T05:33:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T11:09:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121523659164310310870016879846361695293","date":"2025-09-12T10:56:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-11T21:50:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82948997131852674364760740096840985809","date":"2025-09-11T20:50:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-11T14:23:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155225769820027993897980117691406783146","date":"2025-09-11T13:16:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-11T12:39:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299258771716303900925530165564937793833","date":"2025-09-11T12:02:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143580115246038152628499529924233121253","date":"2025-09-07T18:53:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281609220643875398073745912272842656312","date":"2025-09-04T15:23:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T14:03:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-14T11:43:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T07:44:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-11T04:30:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-08-11T04:27:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c6b6bad-9253-49b2-90d1-82720eb608b2","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T13:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-12 14:25:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7111513","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7111513","identity":"rs-7111513","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}