Reducing the number of rigid bronchoscopies performed in suspected foreign body aspiration cases via the use of chest computed tomography: is it safe? A literature review

2014 ◽  
Vol 129 (S1) ◽  
pp. S1-S7 ◽  
Author(s):  
P Tuckett ◽  
A Cervin
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Gold Standard ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Review Of Literature ◽  
Chest Computed Tomography ◽  
Non Invasive ◽  
Life Threatening ◽  
Sensitivity Specificity

AbstractBackground:Foreign body aspiration is common and potentially life threatening. Although rigid bronchoscopy has the potential for serious complications, it is the ‘gold standard’ of diagnosis. It is used frequently in light of the inaccuracy of clinical examination and chest radiography. Computed tomography is proposed as a non-invasive alternative to rigid bronchoscopy.Objective:This study aimed to evaluate the accuracy and safety of computed tomography used in the diagnosis of suspected foreign body aspiration, and compare this with the current gold standard, in order to examine the possibility of using computed tomography to reduce the number of diagnostic rigid bronchoscopies performed.Method:The study comprised a review of literature published from 1970 to 2013, using the PubMed, Scopus, Web of Knowledge, Embase and Medline electronic databases.Results:The sensitivity for computed tomography ranged between 90 and 100 per cent, with four studies demonstrating 100 per cent sensitivity. Specificity was between 75 and 100 per cent. Radiation exposure doses averaged 2.16 mSv.Conclusion:Computed tomography is a sensitive and specific modality in the diagnosis of foreign body aspiration, and its future use will reduce the number of unnecessary rigid bronchoscopies.

scholarly journals Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

2019 ◽  
Vol 5 (4) ◽  
pp. 1129
Author(s):  
Sagar Jawale ◽  
Parthapratim Gupta ◽  
Bharti Kulkarni
Keyword(s):  
Foreign Body ◽  
Gold Standard ◽  
Medical Literature ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Indian Children ◽  
Foreign Body Removal ◽  
Rigid Tube ◽  
Pass Through ◽  
First Time

<p>Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.</p><p> </p>

scholarly journals Bronchial Leech Infestation in a 15-Year-Old Female

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Mohammad Ashkan Moslehi ◽  
Mohammad Hadi Imanieh ◽  
Ali Adib
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Young Children ◽  
Lower Lobe ◽  
Foreign Body Aspiration ◽  
Ground Glass ◽  
Chest Computed Tomography ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the rightB7-8bronchus and removed by forceps and a Dormia basket.

Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree

2014 ◽  
Vol 128 (12) ◽  
pp. 1078-1083 ◽  
Author(s):  
G Behera ◽  
N Tripathy ◽  
Y K Maru ◽  
R K Mundra ◽  
Y Gupta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Multidetector Computed Tomography ◽  
Diagnostic Tool ◽  
Foreign Bodies ◽  
Three Dimensional ◽  
Tracheobronchial Tree ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Virtual Bronchoscopy

AbstractObjectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

scholarly journals Urgent bronchoscopy for foreign body aspiration: 48 children among 1096 patients

Acta Medica ◽  
2019 ◽  
Vol 50 (3) ◽  
pp. 38-43
Author(s):  
Alper Avcı ◽  
Onder Ozden ◽  
Zehra Hatipoglu ◽  
Serdar Onat
Keyword(s):  
Foreign Body ◽  
Postoperative Complications ◽  
Oxygen Saturation ◽  
English Literature ◽  
Length Of Hospital Stay ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Peripheral Oxygen Saturation ◽  
Life Saving ◽  
Life Threatening

Objective: Foreign body aspiration (FBA) is a potentially life-threatening emergency in children. Urgent rigid bronchoscopy (URB) should be performed when presentation includes severe respiratory failure with suspicion for FBA. To the best of the knowledge, this is the first study that evaluates URB in English literature. Methods: Forty-eight patients who underwent URB were included in this study. From the medical records, the patients’ demographic characters, endotracheal intubation status, peripheral oxygen saturation, bronchoscopy results, type and location of foreign body (FB), intra- and postoperative complications and mortality, X-ray, length of hospital stay were evaluated. Results: Twenty-four of the 48 patients were non-intubated. Peripheral oxygen saturation values were 60 ± 14.40 in the preoperative period. No statistical differences were found between intubated and non-intubated patients in terms of intra- and postoperative complications. There were no statistical differences between patients with negative and positive results for bronchoscopy in terms of intra- and postoperative complications. Conclusions: Bronchoscopy is not without risk; however, it is a life-saving procedure. Despite negative FB results, urgent bronchoscopy should be performed in suspicious cases.

scholarly journals Suitability of òhe modality virtual bronchoscopy with aspiration of a foreign body

2018 ◽  
Vol 16 (3) ◽  
pp. 224-232
Author(s):  
M.A. Mitev ◽  
S. Valkanov ◽  
V. Ribarova ◽  
B. Parvanova
Keyword(s):  
Foreign Body ◽  
High Sensitivity ◽  
Tracheobronchial Tree ◽  
Accurate Information ◽  
Virtual Bronchoscopy ◽  
Non Invasive ◽  
Accurate Localization ◽  
Life Threatening ◽  
Sensitivity Specificity ◽  
Inflammatory Changes

Aspirations of foreign bodies are life-threatening among children and elderly patients requiring urgent medical assistance. The aim of the study is to present summarized results from various authors' studies to reveal VB's diagnostic abilities for suspected aspiration of a foreign body. VB has been shown to be a particularly useful non-invasive modality for the complex tracheobronchial tree assessment for suspected aspiration of a foreign body due to its high sensitivity, specificity and validity. MDCT VB with MPR allows accurate localization of the foreign body, but in secondary inflammatory changes and secretions it does not provide accurate information about the form and type of the finding. VB cannot replace FB ("gold standard") but successfully supports and complements it. MDCT could provide early diagnosis in cases of suspected aspiration of a foreign body in children and adults and avoid real bronchoscopy in patients with poor overall condition.

Computerized Scoring System for the Diagnosis of Foreign Body Aspiration in Children

2008 ◽  
Vol 117 (11) ◽  
pp. 839-843 ◽  
Author(s):  
Gili Kadmon ◽  
Yoram Stern ◽  
Efrat Bron-Harlev ◽  
Elhanan Nahum ◽  
Erez Battat ◽  
...  
Keyword(s):  
Foreign Body ◽  
Predictive Model ◽  
Gold Standard ◽  
Foreign Body Aspiration ◽  
Diagnostic Bronchoscopy ◽  
Life Threatening ◽  
Lung Auscultation ◽  
Respiratory Complaints ◽  
Acute Event ◽  
Life Threatening Event

Objectives: Foreign body aspiration (FBA) is a life-threatening event in children. The gold standard for diagnosis is bronchoscopy, but there is no consensus regarding indications for the procedure. The aim of this study was to formulate a predictive model for assessing the probability of FBA in suspected cases as an aid in the decision to perform diagnostic bronchoscopy. Methods: The files of 150 patients who underwent bronchoscopy for suspected FBA at our center between 1996 and 2004 were reviewed for medical history, physical examination, and radiologic studies. The findings were analyzed by logistic regression. Results: Using the file data, we formulated a predictive model wherein each parameter received a numeric coefficient representing its significance in evaluating suspected FBA. The most significant parameters were age 10 to 24 months, foreign body in the child's mouth and severe respiratory complaints during the choking episode, hypoxemia, dyspnea or stridor following the acute event, unilateral signs on lung auscultation, abnormal tracheal radiogram, unilateral infiltrate or atelectasis, and local hyperinflation or obstructive emphysema on chest radiogram. Conclusions: In our predictive model, every case of suspected FBA can be assigned a score based on the specific parameters present, which is then entered into a probability formula to determine the likelihood of a positive diagnosis. This model may serve as a useful tool for deciding on the use of bronchoscopy in all children with suspected FBA.

scholarly journals Pill in the left bronchus-pediatric foreign body aspiration: a case report

2018 ◽  
Vol 4 (2) ◽  
pp. 600
Author(s):  
Raghul Sekar ◽  
Karthikeyan Ramasamy ◽  
Hegde Jyotirmay ◽  
Arun Alexander ◽  
Sunil Kumar Saxena
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Foreign Body ◽  
Pediatric Population ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Mortality And Morbidity ◽  
Left Bronchus

<p>Pediatric population is more prone for accidents such as foreign body aspiration. It is an important and preventable cause of mortality and morbidity in children<strong>.</strong> Pill aspiration is one of the rare causes foreign body aspiration in both children and adults. History is crucial and can guide treatment in case of foreign body aspiration. We present a 5 year old child who had history and examination suggestive of pneumonia which turned out to be a foreign body in left bronchus on computed tomography. The foreign body was a half broken tablet of Co-trimoxazole removed by rigid bronchoscopy without any complication. The child’s symptoms improved satisfactorily following removal. </p>

scholarly journals Left Bronchial Foreign Body Is Always Left Rigid Bronchoscopy an Armour Beyond Barriers in Retrieval-A Case Series

2020 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Foreign Body ◽  
Food Item ◽  
Foreign Bodies ◽  
Case Series ◽  
Clinical Situation ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Bronchial Foreign Body ◽  
Life Threatening ◽  
Airway Foreign Body

Airway foreign bodies (AFBs) is an interdisciplinary area between, Pediatrics and Otolaryngology [1]. Foreign-body aspiration in the airway of children is a life-threatening clinical situation responsible for many deaths each year. Most airway foreign body aspirations occur in children younger than 15 years; children aged 1-3 years are the most susceptible [2]. Vegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated [5]. We present four interesting cases of bronchial foreign bodies that caused diagnostic and therapeutic challenges.

Airway Foreign Body Aspiration

2018 ◽  
Author(s):  
Sarah Nizamuddin ◽  
Caitlin Aveyard
Keyword(s):  
Foreign Body ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Definitive Diagnosis ◽  
Supraglottic Airway ◽  
Intravenous Anesthesia ◽  
Good Communication ◽  
Controlled Ventilation ◽  
Life Threatening ◽  
Volatile Agents

Aspiration of a foreign body is a potentially life-threatening problem that often necessitates an anesthetic for removal of the foreign body. Foreign body aspiration is most common among children aged 1 to 4 years old and has a wide variety of symptoms ranging from a mild, nagging cough to complete airway obstruction. Definitive diagnosis and treatment of foreign body aspiration involve flexible or rigid bronchoscopy. The urgency of the procedure depends on the type of object aspirated and the location of the foreign body in the airway. The appropriate anesthetic for removal of the foreign body is dependent upon the surgeon’s plan and involves several steps in decision-making: intravenous versus inhalational induction, airway maintenance (endotracheal tube vs. supraglottic airway vs. mask), spontaneous versus controlled ventilation, maintenance of anesthesia (total intravenous anesthesia vs. volatile agents). Good communication with the surgeon or proceduralist is key to a safe and effective anesthetic.

Evaluation of computed tomography virtual bronchoscopy in paediatric tracheobronchial foreign body aspiration

2010 ◽  
Vol 124 (8) ◽  
pp. 875-879 ◽  
Author(s):  
K V Bhat ◽  
J S Hegde ◽  
U S Nagalotimath ◽  
G C Patil
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Likelihood Ratio ◽  
Chest Radiography ◽  
Foreign Bodies ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Virtual Bronchoscopy ◽  
Plain Chest ◽  
Tracheobronchial Foreign Body

AbstractObjective:Virtual bronchoscopy is a noninvasive technique which provides an intraluminal view of the tracheobronchial tree. This study aimed to evaluate this technique in comparison with rigid bronchoscopy, in paediatric patients with tracheobronchial foreign bodies undetected by plain chest radiography.Methods:Plain chest radiography was initially performed in 40 children with suspected foreign body aspiration. Computed tomography virtual bronchoscopy was performed in the 20 in whom chest radiography appeared normal. Virtual bronchoscopic images were obtained. All patients underwent rigid bronchoscopy performed by an otolaryngologist blinded to the computed tomography virtual bronchoscopy findings, within 24 hours. Virtual bronchoscopic findings were then compared with the results of rigid bronchoscopy.Results:In 12 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. In one case, a mucous plug was perceived as a foreign body on virtual bronchoscopy. In another case, a minute foreign body was missed on virtual bronchoscopy. The following parameters were calculated: sensitivity, 92.3 per cent; specificity, 85.7 per cent; validity, 90 per cent; positive likelihood ratio, 6.45; and negative likelihood ratio, 0.089.Conclusion:In the presence of a positive clinical diagnosis and negative chest radiography, computed tomography virtual bronchoscopy must be considered in all cases of tracheobronchial foreign body aspiration, in order to avoid needless rigid bronchoscopy. Computed tomography virtual bronchoscopy is particularly useful in screening cases of occult foreign body aspiration, as it has high sensitivity, specificity and validity.

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