Case notes
A 27-year-old Mennonite woman, gravida 9, para 8, was at 37 weeks of pregnancy when she arrived at labor and delivery complaining of a cough that had worsened over the previous several months. At this point, she had increasing dyspnea and upper back pain; these symptoms warranted transportation to our institution for further evaluation.
The patient had 8 full-term vaginal deliveries at home without complications and a known seizure history. She reported that her cough began approximately 7 months earlier, around the time of a dental procedure. Two previous courses of oral antibiotics had been prescribed by her community physician, but these provided no relief.
Physical examination revealed that the fetus was of appropriate size with normal amniotic fluid for her gestational age. The patient’s vital signs were stable, and she was afebrile with no evidence of labor. She was in an orthopneic position but demonstrated labored breathing nonetheless. Her lungs were clear to auscultation, with decreased breath sounds in the left lower base. A chest x-ray revealed a 7 × 14 mm radiopaque foreign object in the left lower lobe ( Figure 1 ); this finding was confirmed with computed tomography ( Figure 2 ). The object was suspected to be an aspirated dental instrument.
