Accidental Inhalation of Scarf Pin: A Distinct Respiratory Emergency

Accidental Inhalation of Scarf Pin: A Distinct Respiratory Emergency | 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 Research Article Accidental Inhalation of Scarf Pin: A Distinct Respiratory Emergency Mehdi Maaroufi, Nahid Zaghba, Wafaa Jalloul, Hanaa Harraz, Zakaria Laklaai, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7368006/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background The accidental inhalation of scarf pins, a growing and preventable respiratory emergency, predominantly affects veiled Muslim women who hold pins in their mouths while adjusting headscarves. This unique cultural hazard poses significant diagnostic and therapeutic challenges and has important public health implications. Objective To present a 20-year institutional experience with scarf pin inhalation, detailing the epidemiological, clinical, and radiological characteristics, management approaches, outcomes, and the importance of preventive strategies. Methods We conducted a retrospective descriptive study at the Respiratory Department of Ibn Rochd University Hospital, Casablanca, Morocco, analyzing medical records of 82 female patients admitted for scarf pin inhalation between January 2005 and January 2025. Data collected included demographic features, clinical presentation, imaging findings, management, outcomes, and procedure-related complications. Results All cases involved veiled Muslim women, primarily adolescents and young adults. Most incidents occurred during hijab adjustment, often precipitated by talking, laughing, or sudden inspiration while holding pins between the lips. The diagnosis was confirmed radiologically in all cases. Management was mainly via bronchoscopy, with surgical intervention reserved for six cases. Conclusion The accidental inhalation of scarf pins represents a rising respiratory emergency closely linked to cultural practices. Increasing healthcare providers' vigilance and implementing focused educational initiatives are crucial steps to lower the occurrence and prevent the complications of this preventable condition. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Tracheobronchial foreign body aspiration is a rare but potentially serious occurrence in adults. Among its increasingly reported forms, the accidental inhalation of scarf pins has emerged as a distinct and concerning respiratory emergency, especially in Muslim-majority societies where the wearing of the veil is a widespread cultural and religious practice. The scarf pin, a slender and pointed metallic device often held between the lips during veil adjustment, may be unexpectedly aspirated during moments of talking, laughing, coughing, or taking a deep breath. Once inhaled, it can lodge in the tracheobronchial tree, leading to a range of respiratory symptoms and, in some cases, severe complications. The growing prevalence of this preventable incident calls attention not only to its diagnostic and therapeutic challenges but also to its broader public health implications. Bronchoscopic retrieval may be technically demanding, and in some cases, surgical intervention becomes necessary. In this article, we aim to shed light on this emerging clinical entity by presenting our institutional experience with scarf pin inhalation over a 20-year period. We will detail the epidemiological, clinical, and radiological features of these cases, describe the management strategies employed, and emphasize the critical importance of preventive measures to address this culturally linked yet avoidable respiratory emergency. Methods We conducted a retrospective descriptive study in the Respiratory Department of Ibn Rochd University Hospital Center in Casablanca, Morocco. Medical records of female patients admitted between January 2005 and January 2025 for accidental scarf pin inhalation were reviewed. A total of 82 cases were identified and included in the analysis. All patients were veiled Muslim women. The variables collected included demographic characteristics, clinical presentation, radiological findings, diagnostic and therapeutic approaches, clinical outcomes, and procedure-related complications. Results The mean age of our patient population, all female and wearing the Islamic veil, was 18.5 years, with an age range of 14 to 37 years. All patients reported a sudden inhalation event occurring during scarf fixation, frequently associated with talking or laughing while holding the pin between their lips. The mean delay between the inhalation and admission to hospital was six days, although this interval varied widely from as short as two hours to as long as one year. Clinically, the most common presenting symptom was an abrupt onset of coughing, consistent with the classical penetration syndrome. Hemoptysis was reported in 5% of cases. The physical examination was normal in the vast majority of patients (92%). The frontal chest X-ray revealed a linear radio-opaque foreign body in all patients. Although the scarf pin was more frequently found in the right bronchial tree, reflecting the anatomical predisposition, the example we present shows it located on the left (see Figure 1). Migration of the pin was observed in some cases, illustrating its mobile nature (see Figure 2). Spontaneous expulsion of the pin by forceful coughing was observed in seven patients (8.5%). Flexible bronchoscopy was employed as the first-line extraction technique in 75 patients, resulting in successful removal in 90.6% of cases (see Figures 3 and 4). In one patient, proximal migration of the pin to the oropharyngeal area led to inadvertent ingestion, necessitating upper gastrointestinal endoscopy for removal. Surgical intervention via thoracotomy was required in six cases due to distal impaction preventing bronchoscopic removal. Bronchoscopy visualization of the foreign body was not possible in 5.33% of cases. All patients received broad-spectrum antibiotics (amoxicillin-clavulanic acid) and a short course of oral corticosteroids to reduce airway inflammation and minimize the risk of post-procedural complications. Discussion The accidental inhalation of scarf pins represents a unique clinical and cultural entity with specific characteristics that differentiate it from other types of foreign body aspiration [1,2]. The scarf pin’s metallic, pointed, and lightweight design facilitates its deep penetration into the bronchial tree, often leading to distal impaction and mucosal embedding [3,4]. This explains both the diagnostic delays observed and the challenges encountered during extraction. Nevertheless, unlike larger choking hazards, the scarf pin rarely causes complete airway obstruction or asphyxia due to its slender profile, which allows partial airflow to continue around it [3,6]. The typical context of this accident is closely linked to cultural practices among veiled Muslim women, predominantly adolescents and young adults, who often hold the pin between their lips or teeth while adjusting the Islamic veil [2,7]. The characteristic posture — head tilted back, talking or laughing — creates a well-documented aspiration risk. This demographic and mechanistic profile explains the homogeneity of patient populations reported in Morocco and other Muslim-majority countries, including Iraq and Egypt [8,9]. Radiographically, the scarf pin is easily identified due to its radio-opaque metal composition, which is a significant advantage compared to organic foreign bodies that may be radiolucent [6,10]. The pin’s migration potential, as observed in our series and illustrated in radiographs, requires careful imaging and sometimes repeated evaluations to track its location prior to intervention [11,12]. This migratory tendency, well described in the literature, increases the complexity of management since it may change position spontaneously between imaging and bronchoscopy [12,13]. Flexible bronchoscopy has become the gold standard for extraction, favored for its minimally invasive nature and capacity to reach distal bronchial segments [10,14,15]. Our series demonstrated a high success rate (90.6%) consistent with international reports [5,10,16]. However, the bronchoscopic removal depends heavily on the operator’s expertise, as some cases may require advanced skills to safely grasp and retrieve the sharp foreign body without causing mucosal injury or further migration [15,17]. In cases of bronchoscopic failure or distal impaction, surgical approaches such as thoracotomy remain imperative [4,18]. The need for surgical intervention in 6 of our cases underscores that despite advances in endoscopic techniques, a small proportion of patients may face more invasive procedures. This aligns with findings from other regional studies, including the work by AbdulJabbar et al., which reported similar diagnostic and therapeutic challenges [9,18,19]. Preventive strategies must therefore be prioritized. Public health education targeting young veiled women — through schools, community and religious centers — can mitigate these risks by raising awareness of the dangers of holding pins in the mouth and advocating safer practices [2,20]. Alternative fastening methods, such as magnetic scarf holders, brooches, or snap fasteners, have been proposed and should be encouraged [20,21]. These culturally sensitive interventions are vital because they address the root cause rather than only managing complications after they arise. Conclusion Scarf pin inhalation represents a preventable yet increasingly common respiratory emergency with distinct epidemiological and clinical features. Early recognition, prompt flexible bronchoscopy, and surgical backup are essential for optimal outcomes. Above all, prevention through education and modification of cultural habits remains the cornerstone of reducing this emerging health issue. Declarations Abbreviations: Not applicable. Ethics approval and consent to participate: According to Moroccan regulations, retrospective case series based on anonymized patient records do not require formal ethical approval. This was confirmed by the Ethics Committee of Ibn Rochd University Hospital Center, Casablanca, Morocco. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent to participate was obtained from all patients. Consent for publication: Written informed consent was obtained from the patients for publication of their anonymized clinical data and images. Availability of data and materials: The datasets used and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request. Competing Interests: The authors declare no competing interests. Funding: None. Authors' contributions: Mehdi Maaroufi had the conception and design of the study, acquisition of data, analysis, and interpretation of data, and drafting of the article. Nahid Zaghba, Wafaa Jalloul, Hanaa Harraz, Zakaria Laklaai, Khadija Chaanoun, Hanane Benjelloun, and Najiba Yassine had the acquisition of data, revising the article critically for important intellectual content. All authors read and approved the final manuscript. Acknowledgements: None. References Kaptanoglu M, Dogan K, Onen A, Kunt N. Turban pin aspirationa potential risk for young Islamic girls. Int J Pediatr Otorhinolaryngol. 1999;48(2):131–5 Rizk N, Gwely EN, Biron LV, Hamza U. 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Headscarf pin tracheobronchial aspirationa distinct clinical entity. Interact Cardiovasc Thorac Surg . 2009;9(2):187–90. Wani ML, Ganie FA, Wani NUD, et al. The pattern, presentation and management of pardah pin inhalationreport from a single center in northern India. Bull Emerg Trauma . 2013; 1(4):171–4. Gencer M, Ceylan E, Koksal N. Extraction of pins from the airway with flexible bronchoscopy. Respiration . 2007;74(6):674–9. Benjelloun H, Zaghba N, Bakhatar A, et al. Les corps étrangers trachéobronchiques chez l'adulte. Pan Afr Med J . 2014;1:220. Hebbazi A, Afif H, El Khattabi W, Aichane A, Bouayad Z. L'épingle à foulardun nouveau corps étranger intra-bronchique. Rev Mal Respir . 2010;27(7):724–8. Tariq SM, Succony L, Bhatia RS. Spontaneous expulsion of a sharp foreign body. J Bronchol Interv Pulmonol . 2012; 19(4):319–22. Al-Ali MAK, Khassawneh B, Alzoubi F. Utility of fiberoptic bronchoscopy for retrieval of aspirated headscarf pins. Respiration . 2007;74(3):309–13. Pham Van L. Extraction de corps étranger intra-bronchique chez l'adulte par fibroscopie bronchique. J Fran Viet Pneu . 2011;2(2):40–3. Gokirmak M, Hasanoglu HC, Koksal N, Yildirim Z, Hacievliyagil SS, Soysal O. Retrieving aspirated pins by flexible bronchoscopy. J Bronchol . 2002;9(1):10–4. Uçcan ES, Tahaoglu K, Mogolkoc N, Dereli S, Basozdemir N, Basok O, et al. Turban pin aspiration syndromea new form of foreign body aspiration. Respir Med . 1996; 90(7):427–8. Caidi M, Kabiri H, Lazrek I, El Maslout A, Ben Osman A. Chirurgie des corps étrangers intra bronchiques. Ann Chir . 2002; 127(6):456–60. Ragab A, Ebied OM, Zalat S. Scarf pins sharp metallic tracheobronchial foreign bodiespresentation and management. Int J Pediatr Otorhinolaryngol . 2007; 71(5):769–73. Ilan O, Eliashar R, Hirshoren N, Hamdan K, Gross M. Turban pin aspirationnew fashion, new syndrome. Laryngoscope . 2012; 122(4):916–9. Cobanoglu U, Can M, Melek M. Turban pin aspirations in children in eastern Anatolia. Indian J Thorac Cardiovasc Surg . 2010;26(1):20–3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 17 Sep, 2025 Editor invited by journal 29 Aug, 2025 Submission checks completed at journal 28 Aug, 2025 First submitted to journal 28 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":214085,"visible":true,"origin":"","legend":"\u003cp\u003eChest X-ray performed on admission showing a linear opacity projecting \u0026nbsp;over the left hilar region corresponding to the scarf pin location (yellow arrow).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7368006/v1/d5e9a2930ca7b4f6ac979a58.png"},{"id":93026833,"identity":"f689c401-5cfd-40ad-a59a-471698633936","added_by":"auto","created_at":"2025-10-08 09:34:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":160181,"visible":true,"origin":"","legend":"\u003cp\u003eFollow-up chest X-ray prior to bronchoscopy demonstrating \u0026nbsp;the migration of the same scarf pin toward the right paracardiac region, \u0026nbsp;thereby illustrating its mobile and migratory nature (red arrow).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7368006/v1/1274e81e06bf656e9d976883.png"},{"id":93026836,"identity":"9a30672e-33a4-41b8-9f21-625d518aec91","added_by":"auto","created_at":"2025-10-08 09:34:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":251580,"visible":true,"origin":"","legend":"\u003cp\u003eBronchoscopic sequence demonstrating the extraction of a scarf pin from the left main bronchus. The pin appeared with its beaded head oriented downward and its sharp metallic tip upward, partially embedded in the bronchial mucosa. A rat-tooth forceps was employed to securely grasp and dislodge the foreign body.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7368006/v1/d1563d42ddb8e52150d43245.png"},{"id":93027693,"identity":"ba77715b-d28d-46b4-bf76-ecbb954dfd61","added_by":"auto","created_at":"2025-10-08 09:42:34","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":293705,"visible":true,"origin":"","legend":"\u003cp\u003eSuccessful extraction of a scarf pin using flexible bronchoscopy.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7368006/v1/b9b020abbdb3f74796a4d4be.png"},{"id":93028063,"identity":"e01c5e52-827c-4a62-80fb-1dbd6e2d9cf9","added_by":"auto","created_at":"2025-10-08 09:50:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1605726,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7368006/v1/4921c802-c457-4f69-985a-01eb5dafa652.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Accidental Inhalation of Scarf Pin: A Distinct Respiratory Emergency","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTracheobronchial foreign body aspiration is a rare but potentially serious occurrence in adults. Among its increasingly reported forms, the accidental inhalation of scarf pins has emerged as a distinct and concerning respiratory emergency, especially in Muslim-majority societies where the wearing of the veil is a widespread cultural and religious practice.\u003c/p\u003e\u003cp\u003eThe scarf pin, a slender and pointed metallic device often held between the lips during veil adjustment, may be unexpectedly aspirated during moments of talking, laughing, coughing, or taking a deep breath. Once inhaled, it can lodge in the tracheobronchial tree, leading to a range of respiratory symptoms and, in some cases, severe complications.\u003c/p\u003e\u003cp\u003eThe growing prevalence of this preventable incident calls attention not only to its diagnostic and therapeutic challenges but also to its broader public health implications. Bronchoscopic retrieval may be technically demanding, and in some cases, surgical intervention becomes necessary.\u003c/p\u003e\u003cp\u003eIn this article, we aim to shed light on this emerging clinical entity by presenting\u003c/p\u003e\u003cp\u003eour institutional experience with scarf pin inhalation over a 20-year period. We will detail the epidemiological, clinical, and radiological features of these cases, describe the management strategies employed, and emphasize the critical importance of preventive measures to address this culturally linked yet avoidable respiratory emergency.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted a retrospective descriptive study in the Respiratory Department of Ibn Rochd University Hospital Center in Casablanca, Morocco. Medical records of female patients admitted between January 2005 and January 2025 for accidental scarf pin inhalation were reviewed. A total of 82 cases were identified and included in the analysis.\u003c/p\u003e\u003cp\u003eAll patients were veiled Muslim women. The variables collected included demographic characteristics, clinical presentation, radiological findings, diagnostic and therapeutic approaches, clinical outcomes, and procedure-related complications.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of our patient population, all female and wearing the Islamic veil, was 18.5 years, with an age range of 14 to 37 years. All patients reported a sudden inhalation event occurring during scarf fixation, frequently associated with talking or laughing while holding the pin between their lips.\u0026nbsp;\u003cbr\u003e\u0026nbsp;The mean delay between the inhalation and admission to hospital was six days, although this interval varied widely from as short as two hours to as long as one year.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinically, the most common presenting symptom was an abrupt onset of coughing, consistent with the classical penetration syndrome. Hemoptysis was reported in 5% of cases. The physical examination was normal in the vast majority of patients (92%).\u003c/p\u003e\n\u003cp\u003eThe frontal chest X-ray revealed a linear radio-opaque foreign body in all patients. Although the scarf pin was more frequently found in the right bronchial tree, reflecting the anatomical predisposition, the example we present shows it located on the left (see Figure 1). Migration of the pin was observed in some cases, illustrating its mobile nature (see Figure 2).\u003c/p\u003e\n\u003cp\u003eSpontaneous expulsion of the pin by forceful coughing was observed in seven patients (8.5%). Flexible bronchoscopy was employed as the first-line extraction technique in 75 patients, resulting in successful removal in 90.6% of cases (see Figures 3 and 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn one patient, proximal migration of the pin to the oropharyngeal area led to inadvertent ingestion, necessitating upper gastrointestinal endoscopy for removal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurgical intervention via thoracotomy was required in six cases due to distal impaction preventing bronchoscopic removal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBronchoscopy visualization of the foreign body was not possible in 5.33% of cases.\u003c/p\u003e\n\u003cp\u003eAll patients received broad-spectrum antibiotics (amoxicillin-clavulanic acid) and a short course of oral corticosteroids to reduce airway inflammation and minimize the risk\u0026nbsp;\u003cbr\u003e\u0026nbsp;of post-procedural complications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe accidental inhalation of scarf pins represents a unique clinical and cultural entity with specific characteristics that differentiate it from other types of foreign body aspiration [1,2]. The scarf pin\u0026rsquo;s metallic, pointed, and lightweight design facilitates its deep penetration into the bronchial tree, often leading to distal impaction and mucosal embedding [3,4]. This explains both the diagnostic delays observed and the challenges encountered during extraction. Nevertheless, unlike larger choking hazards, the scarf pin rarely causes complete airway obstruction or asphyxia due to its slender profile, which allows partial airflow to continue around it [3,6].\u003c/p\u003e\u003cp\u003eThe typical context of this accident is closely linked to cultural practices among\u003c/p\u003e\u003cp\u003eveiled Muslim women, predominantly adolescents and young adults, who often\u003c/p\u003e\u003cp\u003ehold the pin between their lips or teeth while adjusting the Islamic veil [2,7].\u003c/p\u003e\u003cp\u003eThe characteristic posture \u0026mdash; head tilted back, talking or laughing \u0026mdash; creates a well-documented aspiration risk. This demographic and mechanistic profile explains the homogeneity of patient populations reported in Morocco and other Muslim-majority countries, including Iraq and Egypt [8,9].\u003c/p\u003e\u003cp\u003eRadiographically, the scarf pin is easily identified due to its radio-opaque metal composition, which is a significant advantage compared to organic foreign bodies that may be radiolucent [6,10]. The pin\u0026rsquo;s migration potential, as observed in our series and illustrated in radiographs, requires careful imaging and sometimes repeated evaluations to track its location prior to intervention [11,12]. This migratory tendency, well described in the literature, increases the complexity of management since it may change position spontaneously between imaging and bronchoscopy [12,13].\u003c/p\u003e\u003cp\u003eFlexible bronchoscopy has become the gold standard for extraction, favored for its minimally invasive nature and capacity to reach distal bronchial segments [10,14,15]. Our series demonstrated a high success rate (90.6%) consistent with international reports [5,10,16]. However, the bronchoscopic removal depends heavily on the operator\u0026rsquo;s expertise, as some cases may require advanced skills to safely grasp and retrieve the sharp foreign body without causing mucosal injury or further migration [15,17]. In cases of bronchoscopic failure or distal impaction, surgical approaches such as thoracotomy remain imperative [4,18].\u003c/p\u003e\u003cp\u003eThe need for surgical intervention in 6 of our cases underscores that despite advances in endoscopic techniques, a small proportion of patients may face more invasive procedures. This aligns with findings from other regional studies, including the work by AbdulJabbar\u003c/p\u003e\u003cp\u003eet al., which reported similar diagnostic and therapeutic challenges [9,18,19].\u003c/p\u003e\u003cp\u003ePreventive strategies must therefore be prioritized. Public health education targeting young veiled women \u0026mdash; through schools, community and religious centers \u0026mdash; can mitigate these risks by raising awareness of the dangers of holding pins in the mouth and advocating safer practices [2,20]. Alternative fastening methods, such as magnetic scarf holders, brooches, or snap fasteners, have been proposed and should be encouraged [20,21]. These culturally sensitive interventions are vital because they address the root cause rather than only managing complications after they arise.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eScarf pin inhalation represents a preventable yet increasingly common respiratory emergency with distinct epidemiological and clinical features. Early recognition, prompt flexible bronchoscopy, and surgical backup are essential for optimal outcomes. Above all, prevention through education and modification of cultural habits remains the cornerstone of reducing this emerging health issue.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eAccording to Moroccan regulations, retrospective case series based on anonymized patient records do not require formal ethical approval. This was confirmed by the Ethics Committee of Ibn Rochd University Hospital Center, Casablanca, Morocco.\u0026nbsp;The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent to participate was obtained from all patients.\u003cbr\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from the patients for publication of their anonymized clinical data and images.\u003cbr\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.\u003cbr\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003cbr\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMehdi Maaroufi had the conception and design of the study, acquisition of data, analysis, and interpretation of data, and drafting of the article. Nahid Zaghba, Wafaa Jalloul, Hanaa Harraz, Zakaria Laklaai, Khadija Chaanoun, Hanane Benjelloun, and Najiba Yassine had the acquisition of data, revising the article critically for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKaptanoglu M, Dogan K, Onen A, Kunt N. Turban pin aspirationa potential risk for young Islamic girls. Int J Pediatr Otorhinolaryngol. 1999;48(2):131\u0026ndash;5\u003c/li\u003e\n\u003cli\u003eRizk N, Gwely EN, Biron LV, Hamza U. Metallic hairpin inhalationa healthcare problem facing young Muslim females. \u003cem\u003eJ Otolaryngol Head Neck Surg\u003c/em\u003e. 2014; 43(1):21.\u003c/li\u003e\n\u003cli\u003eZaghba N, Benjelloun H, Bakhatar A, et al. Epingle \u0026agrave; foulardun corps \u0026eacute;tranger intra-bronchique qui n\u0026apos;est plus habituel. \u003cem\u003eRev Pneumol Clin\u003c/em\u003e. 2013;69(2):65\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eArsalane A, Zidane A, et al. Deux cas d\u0026apos;extraction chirurgicale de corps \u0026eacute;trangers apr\u0026egrave;s inhalation d\u0026apos;\u0026eacute;pingle de foulard. \u003cem\u003eRev Pneumol Clin\u003c/em\u003e. 2009; 65(5):293\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eKaptanoglu M, Nadir A, Dogan K, Sahin E. The heterodox nature of \u0026quot;turban pins\u0026quot; in foreign body aspirationthe Central Anatolian experience. \u003cem\u003eInt J Pediatr Otorhinolaryngol\u003c/em\u003e. 2007; 71(4):553\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eHamad AMM, Elmistekawy EM, Ragab SM. Headscarf pin, a sharp foreign body aspiration with particular clinical characteristics. \u003cem\u003eEur Arch Otorhinolaryngol\u003c/em\u003e. 2010;267(12):1957\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eEl Ftouh M, Souhi H, et al. Inhalation d\u0026apos;\u0026eacute;pingleparticularit\u0026eacute;s de ce corps \u0026eacute;tranger. \u003cem\u003eMaroc M\u0026eacute;dical\u003c/em\u003e. 2010;32(3):211\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eAl-Sarraf N, Jamal-Eddine H, Khaja F, Ayed AK. Headscarf pin tracheobronchial aspirationa distinct clinical entity. \u003cem\u003eInteract Cardiovasc Thorac Surg\u003c/em\u003e. 2009;9(2):187\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eWani ML, Ganie FA, Wani NUD, et al. The pattern, presentation and management of pardah pin inhalationreport from a single center in northern India. \u003cem\u003eBull Emerg Trauma\u003c/em\u003e. 2013; 1(4):171\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eGencer M, Ceylan E, Koksal N. Extraction of pins from the airway with flexible bronchoscopy. \u003cem\u003eRespiration\u003c/em\u003e. 2007;74(6):674\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eBenjelloun H, Zaghba N, Bakhatar A, et al. Les corps \u0026eacute;trangers trach\u0026eacute;obronchiques chez l\u0026apos;adulte. \u003cem\u003ePan Afr Med J\u003c/em\u003e. 2014;1:220.\u003c/li\u003e\n\u003cli\u003eHebbazi A, Afif H, El Khattabi W, Aichane A, Bouayad Z. L\u0026apos;\u0026eacute;pingle \u0026agrave; foulardun nouveau corps \u0026eacute;tranger intra-bronchique. \u003cem\u003eRev Mal Respir\u003c/em\u003e. 2010;27(7):724\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eTariq SM, Succony L, Bhatia RS. Spontaneous expulsion of a sharp foreign body. \u003cem\u003eJ Bronchol Interv Pulmonol\u003c/em\u003e. 2012; 19(4):319\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eAl-Ali MAK, Khassawneh B, Alzoubi F. Utility of fiberoptic bronchoscopy for retrieval of aspirated headscarf pins. \u003cem\u003eRespiration\u003c/em\u003e. 2007;74(3):309\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003ePham Van L. Extraction de corps \u0026eacute;tranger intra-bronchique chez l\u0026apos;adulte par fibroscopie bronchique. \u003cem\u003eJ Fran Viet Pneu\u003c/em\u003e. 2011;2(2):40\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eGokirmak M, Hasanoglu HC, Koksal N, Yildirim Z, Hacievliyagil SS, Soysal O. Retrieving aspirated pins by flexible bronchoscopy. \u003cem\u003eJ Bronchol\u003c/em\u003e. 2002;9(1):10\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eU\u0026ccedil;can ES, Tahaoglu K, Mogolkoc N, Dereli S, Basozdemir N, Basok O, et al. Turban pin aspiration syndromea new form of foreign body aspiration. \u003cem\u003eRespir Med\u003c/em\u003e. 1996; 90(7):427\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eCaidi M, Kabiri H, Lazrek I, El Maslout A, Ben Osman A. Chirurgie des corps \u0026eacute;trangers intra bronchiques. \u003cem\u003eAnn Chir\u003c/em\u003e. 2002; 127(6):456\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eRagab A, Ebied OM, Zalat S. Scarf pins sharp metallic tracheobronchial foreign bodiespresentation and management. \u003cem\u003eInt J Pediatr Otorhinolaryngol\u003c/em\u003e. 2007; 71(5):769\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003eIlan O, Eliashar R, Hirshoren N, Hamdan K, Gross M. Turban pin aspirationnew fashion, new syndrome. \u003cem\u003eLaryngoscope\u003c/em\u003e. 2012; 122(4):916\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eCobanoglu U, Can M, Melek M. Turban pin aspirations in children in eastern Anatolia. \u003cem\u003eIndian J Thorac Cardiovasc Surg\u003c/em\u003e. 2010;26(1):20\u0026ndash;3.\u003c/li\u003e\n\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-7368006/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7368006/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe accidental inhalation of scarf pins, a growing and preventable respiratory emergency, predominantly affects veiled Muslim women who hold pins in their mouths while adjusting headscarves. This unique cultural hazard poses significant diagnostic and therapeutic challenges and has important public health implications.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo present a 20-year institutional experience with scarf pin inhalation, detailing the epidemiological, clinical, and radiological characteristics, management approaches, outcomes, and the importance of preventive strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective descriptive study at the Respiratory Department of Ibn Rochd University Hospital, Casablanca, Morocco, analyzing medical records of 82 female patients admitted for scarf pin inhalation between January 2005 and January 2025. Data collected included demographic features, clinical presentation, imaging findings, management, outcomes, and procedure-related complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll cases involved veiled Muslim women, primarily adolescents and young adults. Most incidents occurred during hijab adjustment, often precipitated by talking, laughing, or sudden inspiration while holding pins between the lips. The diagnosis was confirmed radiologically in all cases. Management was mainly via bronchoscopy, with surgical intervention reserved for six cases.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe accidental inhalation of scarf pins represents a rising respiratory emergency closely linked to cultural practices. Increasing healthcare providers' vigilance and implementing focused educational initiatives are crucial steps to lower the occurrence and prevent the complications of this preventable condition.\u003c/p\u003e","manuscriptTitle":"Accidental Inhalation of Scarf Pin: A Distinct Respiratory Emergency","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:34:30","doi":"10.21203/rs.3.rs-7368006/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-14T12:26:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T08:31:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181081368248794040604015183634537332222","date":"2025-10-09T06:23:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301238001325009283731118999361852784227","date":"2025-10-04T21:49:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T15:25:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114851057370369496348459916532087718225","date":"2025-09-25T13:48:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T13:23:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T04:33:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T13:59:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T16:52:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-08-28T16:49:43+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":"c37c2acf-4eca-4675-b3b6-265d7e9c50c2","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T09:34:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 09:34:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7368006","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7368006","identity":"rs-7368006","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}