Patient 1: Figure 1 a – d:
Supine chest radiographs in a 7-month-old infant girl with an aspirated Devil’s thorn
  1. Soft-tissue density foreign body is noted in the subglottic region (blue arrow) with visible subglottic oedema of the soft tissues and a ‘steepling’ appearance of the airway. The remainder of the airway appears normal but there is volume loss of the right lung (compared to the left) with some atelectasis in the right mid-zone.
  2. Follow-up radiograph after urgent intubation due to severe respiratory distress, demonstrates the tip of the endo-tracheal tube just above the carina, but now the right middle and lower lobes are hyper-expanded compared to previously, and compared to the left lung suggesting a ball valve type obstruction of the bronchus intermedius. In addition, there is increased density and mild volume loss of the right upper lobe.
  3. Devil’s thorn located at the entrance of the RMB
  4. Thorn moved into a basket, noted that the thorn is covered with slimy mucus
  5. Thorn moved into the subglottic region and removed with rigid forceps because it kept slipping out of basket
  6. Post removal injury to the vocal cords is visible
  7. Picture of the thorn demonstrating the horns