Complications of tracheobronchial foreign body aspiration in children: report of 5 cases and review of the literature

Foreign body aspiration (FBA) is one of leading causes of death in children, especially among those younger than 3 years of age. The inhalation of a foreign body may cause a wide variety of symptoms, and early diagnosis is highly associated with the successful removal of the inhaled foreign material. Despite the great advances in endoscopic procedures and anesthesia, a large number of difficulties and complications still result from foreign body aspiration. We describe 5 cases of serious acute complications following aspiration of foreign bodies that became lodged in the tracheobronchial tree, including pneumomediastinum, pneumothorax, total atelectasis, foreign body dislodgment, and need for thoracotomy in children admitted into our intensive care unit in 1999 and 2000; these were all situations that could have been prevented with early recognition and prompt therapeutic intervention.

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Hypodermic Needles: An Unusual Tracheobronchial Foreign Body

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948709600618 ◽

1987 ◽

Vol 96 (6) ◽

pp. 698-700 ◽

Cited By ~ 11

Author(s):

Moses Nussbaum ◽

Michael Nash ◽

Jason Cohen ◽

Hyun Cho ◽

Robert Pincus

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Medical Literature ◽

Case Reports ◽

Tracheobronchial Tree ◽

Acute Complications ◽

Tracheobronchial Foreign Body ◽

Ancient Times

Case reports of foreign bodies in the upper aerodigestive regions and descriptions of the various methods used to retrieve them have been recorded in the medical literature since ancient times. Sharp, penetrating foreign bodies are most dangerous and may cause acute complications if they perforate the air and food passages. Recently, the authors encountered nine cases of hypodermic needles in the tracheobronchial tree. Seven of the nine needles were removed endoscopically without complications and two were expelled by the patients.

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Karakteristik pasien benda asing trakeobronkial di bagian T.H.T.K.L Rumah Sakit Dr. Mohammad Hoesin Palembang

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v47i2.225 ◽

2018 ◽

Vol 47 (2) ◽

pp. 164

Author(s):

Puspa Zuleika ◽

Abla Ghanie

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Tracheobronchial Tree ◽

Foreign Body Aspiration ◽

The Body ◽

X Rays ◽

X Ray ◽

Tracheobronchial Foreign Body ◽

History Of ◽

Chest X Ray

Latar belakang: Aspirasi benda asing ialah masuknya benda yang berasal dari luar atau dalam tubuh, ke saluran trakeobronkial. Aspirasi benda asing saluran trakeobronkial merupakan keadaan darurat yang memerlukan tindakan bronkoskopi segera untuk mencegah komplikasi yang lebih serius. Tujuan: Mengidentifikasi karakteristik klinis pasien aspirasi benda asing saluran trakeobronkial di bagian Telinga Hidung Tenggorok – Bedah Kepala Leher (T.H.T.K.L) Fakultas Kedokteran Universitas Sriwijaya/ Rumah Sakit Dr. Mohammad Hoesin Palembang. Metode: Penelitian ini merupakan penelitian observasional deskriptif. Sampel penelitian ini diambil dari data rekam medis pasien aspirasi benda asing pada saluran trakeobronkial di Rumah Sakit Dr. Mohammad Hoesin Palembang periode Januari 2012 - Desember 2016. Hasil: Didapatkan 20 pasien dengan riwayat teraspirasi benda asing di saluran trakeobronkial. Dijumpai 9 orang laki-laki dan 11 orang perempuan dengan perbandingan 1:1,2, di mana usia 0-15 tahun merupakan penderita terbanyak aspirasi benda asing ini. Benda asing yang paling banyak ditemukan adalah mainan dan benda plastik sebanyak 9 kasus, serta jarum pentul sebanyak 6 kasus. Sebanyak 19 pasien diketahui terdapat riwayat tersedak benda asing. Pemeriksaan foto toraks menunjukkan gambaran normal pada 12 pasien. Lokasi benda asing terbanyak ditemukan di trakea sebanyak 8 kasus. Kesimpulan: Aspirasi benda asing di saluran trakeobronkial sering terjadi pada anak-anak yang berusia kurang dari 15 tahun. Benda asing terbanyak adalah anorganik berupa mainan dan benda plastik. Pemeriksaan radiologi paru dalam 24 jam pertama setelah kejadian aspirasi pada umumnya menunjukkan gambaran normal. Lokasi benda asing di saluran trakeobronkial terbanyak pada penelitian ini adalah di trakea. Kata kunci: Aspirasi, bronkoskopi, foto toraks, benda asing, traktus trakeobronkial ABSTRACT Background: Foreign body aspiration is the entrance of foreign objects from outside or inside of the body into the tracheobronchial tract. Aspiration of foreign body in tracheobronchial tract is an emergency condition that needs immediate bronchoscopy procedure to prevent serious complications. Objectives: To identify clinical characteristics of foreign body aspiration patients in ENT Department Sriwijaya Medical Faculty / Dr. Mohammad Hoesin Hospital, Palembang. Method: This study was a descriptive observational study. The sample of this study was taken from the medical record of tracheobronchial foreign body aspiration patients at Dr. Mohammad Hoesin Hospital from January 2012 until December 2016. Result: There were twenty patients with the history of foreign body aspiration in tracheobronchial tract, consisted of 9 male and 11 female, with the ratio 1:1,2, in which 0–15 year-old children were the majority of the patients. The most common foreign bodies were toys and plastic objects in 9 cases and head veil pin in 6 cases. Nineteen cases of the patients had the history of choking as presenting symptom. Chest X-Ray showed normal imaging on twelve patients. The most common site in tracheobronchial tract where foreign bodies found was the trachea, in eight cases. Conclusions: Foreign body aspirations in tracheobronchial tract were most frequently happened in children less than 15 year-old. The most common foreign bodies were anorganic material, such as toys and plastic objects. Lung X-Rays on the first 24 hours commonly showed normal imaging. Foreign bodies in tracheobronchial tracts most frequently were found in the trachea. Keywords: Aspirations, bronchoscopy, chest X-Ray, foreign body, tracheobronchial tree

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002837 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1078-1083 ◽

Cited By ~ 15

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.

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A Case of Whistle as Foreign Body in Trachea

BioScientia Medicina ◽

10.32539/bsm.v6i1.434 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1281-1286

Author(s):

Puspa Zuleika

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Pediatric Patients ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Object ◽

Case Presentation ◽

Foreign Body Extraction ◽

Tracheobronchial Foreign Body ◽

History Of

Background. Most of foreign body aspiration cases are found in children under the age of fifteen. Pediatric patients often presents with non-food foreign body aspiration, such as toys. The most common clinical manifestation are history of choking following foreign object insertion into the mouth (85%), paroxysmal cough (59%), wheezing (57%) and airway obstruction (5%). Case presentation. Main principle of airway foreign body extraction is to do it immediately in the most optimal condition with slightest possible trauma. Rigid bronchoscopy is a suitable choice for tracheal foreign body extraction. We reported a case of seven years old male with tracheal foreign body presented with history of whistle ingestion five hours prior to admission. This patient was discharged from hospital after third days of rigid bronchoscopy procedure. Conclusion. History of foreign body aspiration in children should be suspected as a tracheobronchial foreign body. Rigid bronchoscopy is preferred to extract foreign bodies present in the trachea. The prognosis for tracheobronchial foreign body aspiration is good if the foreign body is treated early and without complications.

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Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Medicinski pregled ◽

10.2298/mpns14s1069d ◽

2014 ◽

Vol 67 (suppl. 1) ◽

pp. 69-74

Author(s):

Danijela Dragicevic ◽

Ljiljana Jovancevic ◽

Rajko Jovic ◽

Ljiljana Vlaski ◽

Bojan Bozic

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Main Bronchus ◽

Age Groups ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Radiological Findings ◽

Tracheobronchial Foreign Body ◽

The Moment ◽

The Right

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients? age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

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Tooth as a foreign body in trachea mimicking asthma in an adult patient

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200160 ◽

2020 ◽

Vol 6 (2) ◽

pp. 403

Author(s):

Ankur Batra ◽

Megha Goyal

Keyword(s):

Case Report ◽

Foreign Body ◽

Adult Patient ◽

Early Recognition ◽

Foreign Body Aspiration ◽

Progressive Dyspnoea ◽

Radiological Findings ◽

Tracheobronchial Foreign Body ◽

Life Threatening

<p class="abstract">Tracheobronchial foreign body aspiration is a life threatening emergency that requires prompt removal, but sometimes it may remain undetected because of atypical history, or misleading clinical and radiological findings. We present a case report of a 32 years old female who presented with progressive dyspnoea, misdiagnosed as asthma, not responding to bronchodilators and finally diagnosed as foreign body in trachea. The inclusion of foreign body aspiration in the differential for such patients allows for early recognition and appropriate management.</p>

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Office Removal of a Subglottic Bread Clip

Case Reports in Otolaryngology ◽

10.1155/2013/480676 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

David E. Rosow ◽

Si Chen

Keyword(s):

Foreign Body ◽

Unusual Case ◽

Foreign Bodies ◽

Upper Airway ◽

Tracheobronchial Tree ◽

Life Threatening ◽

Successful Removal ◽

Lidocaine Spray ◽

Threatening Situation ◽

Unusual Case Report

Objective. The presence of an upper airway foreign body is an emergent, potentially life-threatening situation that requires careful but rapid evaluation and management. Organic or nonorganic material may typically be found in the pyriform sinuses or tongue base or may be aspirated directly into the tracheobronchial tree. We present here an unusual case report of a patient who accidentally ingested a plastic bread clip that was lodged in his subglottis for 15 months and report successful removal in the office under local anesthesia.Methods. Mucosal anesthesia was achieved with inhaled 4% lidocaine spray. Flexible laryngoscopic removal of the foreign body was then successfully accomplished.Results. The patient’s symptoms resolved completely following removal, with no sequelae.Conclusions. Office removal of airway foreign bodies is feasible and can be safely done with adequate topical anesthesia, but great caution and emergency planning must be exercised.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000769 ◽

2010 ◽

Vol 124 (8) ◽

pp. 875-879 ◽

Cited By ~ 29

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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Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors

BMC Surgery ◽

10.1186/s12893-021-01089-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weigang Gan ◽

Ning Xiao ◽

Yiyuan Feng ◽

Danmei Zhou ◽

Juanjuan Hu ◽

...

Keyword(s):

Foreign Body ◽

Pediatric Patients ◽

Treatment Delay ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

External Factors ◽

Factors Affecting ◽

Intrinsic Factors ◽

Common Location ◽

Tracheobronchial Foreign Body

Abstract Background Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. Methods We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. Results The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. Conclusion Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

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Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1718964 ◽

2021 ◽

Author(s):

Darwin Kaushal ◽

Amit Goyal ◽

Kapil Soni ◽

Bikram Choudhury ◽

Nithin Prakasan Nair ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Preoperative Planning ◽

Rigid Bronchoscopy ◽

Delayed Presentation ◽

Betel Nut ◽

Key Factors ◽

Tracheobronchial Foreign Body ◽

Institutional Experience ◽

Definitive Management

Abstract Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

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