Tracheobronchial foreign body aspiration in children: a 5-year retrospective study from Shanghai, China

2019 ◽  
Author(s):  
Guodong Ding ◽  
Beirong Wu ◽  
Angela Vinturache ◽  
Chen Cai ◽  
Min Lu ◽  
...  
Keyword(s):  
Foreign Body ◽  
Descriptive Analysis ◽  
Sudden Onset ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Older Children ◽  
Female Ratio ◽  
X Ray ◽  
Presenting Symptoms ◽  
First Choice

Abstract Background Foreign body (FB) aspiration is a common and serious problem in childhood, but little information is available about this condition in Chinese context. We aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population. Methods A retrospective review of medical records of children aged 0-14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between 2013 and 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs. Results Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years. The male to female ratio was 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. Eleven percent were laryngotracheal FBs and 89% were bronchial FBs. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal x-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. In children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was successfully performed in 80.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during bronchoscopy due to acute respiratory failure. Conclusions Tracheobronchial FBs should be suspected in children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent. Flexible bronchoscopy has become the first choice in China used for FB removal from airways in children.

scholarly journals Foreign Body Aspiration in Infants and Older Children: A Comparative Study

2019 ◽  
Vol 99 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Shorook Na’ara ◽  
Igor Vainer ◽  
Moran Amit ◽  
Arie Gordin
Keyword(s):  
Foreign Body ◽  
Medical Center ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Foreign Body Aspiration ◽  
Preschool Age ◽  
Small Airways ◽  
Older Children ◽  
X Ray ◽  
Young Infants

Background: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. Methods: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. Results: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents ( P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants’ group ( P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms ( P < .05), location of the FB ( P < .001), and witnessed aspiration ( P < .001) were independent prognostic factors for the length of hospitalization. Conclusion: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.

scholarly journals A gyermekkori alsó légúti idegentest-aspiráció diagnosztikája a klinikai gyakorlatban

2018 ◽  
Vol 159 (51) ◽  
pp. 2162-2166
Author(s):  
Dániel Hajnal ◽  
Tamás Kovács
Keyword(s):  
Foreign Body ◽  
Standard Procedure ◽  
False Negative ◽  
Radiological Finding ◽  
Paediatric Population ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
X Ray ◽  
Co Morbidity ◽  
Chest X Ray

Abstract: Introduction and aim: Rigid bronchoscopic foreign body removal is the gold standard procedure for foreign body aspiration. We have analysed our results of bronchoscopies and the accuracy of diagnosis among the paediatric population in Southeast Hungary. Method: A retrospective study of children admitted because of suspected solid foreign body aspiration between 2006 and 2017 was performed. Results: From among 220 admitted patients, 86 were suspected of solid particle aspiration. Presenting history was certain in 68.6% (n = 59/86). Sudden choking-like symptoms were present in 61/86 patients (70.9%), coughing in 81/86 patients (94.2%). Thoracic auscultation was positive in 67/86 cases (77.9%), chest X-ray in 75/86 patients (87.2%), while fluoroscopy only in 12/75 cases (16%). 92 bronchoscopies in 86 patients were performed. In 57 bronchoscopies, solid foreign body was found (66.2%) and the removal was successful in 56 cases. Thoracic auscultation was negative in patients with foreign body only in 6/57 cases (10.5%). In the same group, chest X-ray was negative in 33/57 cases (57.9%) and fluoroscopy was positive only in 12/57 patients (21.1%). Pneumonia or prolonged bronchitis was present in 4/86 patients (4.6%). Severe bronchial bleeding occurred in 2/86 cases (2.3%). Mortality was 1.2%, a child with severe co-morbidity and chronic aspiration passed away. Bronchoscopy was negative in 29/86 patients (33.7%). Complications were significantly higher in chronic cases than in the acute ones. Conclusion: Rigid bronchoscopy is indicated if solid foreign body aspiration is suspected and positive anamnesis, typical symptoms (coughing, choking) or positive chest auscultations are present. Diagnosis predominantly based on radiological finding is controversial due to the high possibility of false negative results. Early intervention within the first 24 hours is recommended to avoid complications. Orv Hetil. 2018; 159(51): 2162–2166.

scholarly journals Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

2019 ◽  
Vol 5 (6) ◽  
pp. 1552
Author(s):  
Kunzes Dolma ◽  
Anchal Gupta ◽  
Apurab Gupta ◽  
Padam Singh Jamwal
Keyword(s):  
Foreign Body ◽  
Clinical Examination ◽  
Foreign Bodies ◽  
Standard Procedure ◽  
Neck Surgery ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
Delay In Diagnosis

<p class="abstract"><strong>Background:</strong> The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.</p><p class="abstract"><strong>Methods:</strong> The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied.  </p><p class="abstract"><strong>Results:</strong> The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.</p><p><strong>Conclusions:</strong> History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies. </p>

scholarly journals Unusual foreign bodies of the airway: a case series regarding their management

2018 ◽  
Vol 4 (4) ◽  
pp. 1089
Author(s):  
Aishwarya Ullal ◽  
Sanjeev Mishra ◽  
R. K. Mundra
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Case Series ◽  
Rigid Bronchoscopy ◽  
Lateral View ◽  
Virtual Bronchoscopy ◽  
X Rays ◽  
X Ray ◽  
Radiological Studies ◽  
Respiratory Reflexes

<p>Foreign bodies in the bronchi are a common problem seen by ENT surgeons. Bronchial foreign bodies are common in children because they have difficulty in swallowing hard foodstuffs such as nuts and have an inadequately developed protective respiratory reflexes, which makes them vulnerable to inhalation of foreign bodies This is a case series of four unusual cases of foreign body airway, that presented to our ENT OPD, after taking detailed history and clinical examination, these patients were subjected to radiological studies such as chest X-rays, X-ray soft tissue lateral view, virtual bronchoscopy and CT chest to confirm the foreign body, after taking informed consent rigid bronchoscopy was performed and foreign body extracted.</p>

scholarly journals Flexible Bronchoscopy Combined with Rigid Bronchoscopy for Treatment of Scarring in the Bronchus Caused by a Foreign Body

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Lei Wu ◽  
Yuanjian Sheng ◽  
Xuefeng Xu ◽  
Zhimin Chen ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Foreign Body ◽  
Granulation Tissue ◽  
Scar Tissue ◽  
Tracheobronchial Tree ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Interventional Bronchoscopy ◽  
Pediatric Department

Foreign body (FB) aspiration into the tracheobronchial tree is an emergency in the pediatric department, particularly in children aged <3 years. FB granulation tissue is commonly found in children with FB aspiration. However, scarring in the bronchus caused by a FB is rare. We herein report a case involving aspiration of a plastic whistle toy with scarring in the bronchus. The scar tissue was successfully removed by interventional bronchoscopy combined with a flexible electrosurgery probe and carbon dioxide cryotherapy.

scholarly journals Surgery of Eventration of the Diaphragm

2021 ◽  
Vol 63 (2) ◽  
pp. 57-59
Author(s):  
Waleed M. Hussen ◽  
Ahmed M. Mohammed ◽  
Akeel S. Yuser
Keyword(s):  
Phrenic Nerve ◽  
Surgical Repair ◽  
Female Ratio ◽  
X Ray ◽  
Presenting Symptoms ◽  
Left Hemidiaphragm ◽  
Eventration Of Diaphragm ◽  
Chest X Ray ◽  
Male To Female ◽  
Eventration Diaphragm

Abstract Background: Eventration of diaphragm is an abnormal elevation of the diaphragm. Publishing on eventration of diaphragm in Iraq is scarce. Objective: This study was carried out to report on the Iraqi experience on eventration of diaphragm. Methods: A total of 18 patients with eventration diaphragm were included in this study. A review of case records of patients with eventration diaphragm treated in Ibn Al-Nafees Teaching Hospital was done. Review of records took place for the period of March 2012 to Dec. 2017. Results: The age of patients was ranged 5 months to 70 years, giving male to female ratio of 2:1. Dyspnea was dominating presenting symptoms followed by cough. The left hemidiaphragm was the most affected site (83.3%). The cause of eventration of diaphragm was idiopathic in 72.2% of patients. Chest X ray showed the elevation of the affected hemidiaphragm. CT scan demonstrated the thinned-out raised hemidiaphragm. The most common complications were atelectasis, and recurrent chest infection. Hospital stay was ranging 4-14 days. Conclusion: Eventration of diaphragm is not uncommon in Iraq. Presentation, management, and complication are similar to that reported in global centers.   Key words:  Diaphragm. Eventration.  Plication. Surgical repair. Phrenic nerve injury  

scholarly journals SEX AND AGE WISE DISTRIBUTION, PRESENTATION AND SUCCESSFUL REMOVAL AND MORTALITY OF FOREIGN BODY ASPIRATION USING RIGID BRONCHOSCOPE IN CHILDREN OF DISTRICT D.I.KHAN, PAKISTAN

2020 ◽  
Vol 18 (01) ◽  
pp. 3-11
Author(s):  
Ali Khan ◽  
Mohammad Ismail Khan ◽  
Muhammad Afaq Ali ◽  
Altaf Hussain ◽  
Muhammad Ibrahim ◽  
...  
Keyword(s):  
Foreign Body ◽  
Age Groups ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Age Group ◽  
Mortality And Morbidity ◽  
X Ray ◽  
Medical College ◽  
History Of ◽  
Successful Removal

Background: Foreign body aspiration commonly occurs in young children and is associated with high degree of mortality and morbidity. The objectives of this study were to determine epidemiologic, clinical and endoscopic perspectives of foreign body aspiration in children of District D.I.Khan, Pakistan. Materials & Methods: This descriptive study was conducted in Department of ENT, Gomal Medical College/ DHQ Teaching Hospital, D.I.Khan, Pakistan from November 2017-April 2019. 105 children with suspected foreign body (FB) aspiration were included. All patients underwent rigid bronchoscopy under GA. After check X-ray and one day observation, they were discharged. Variables were sex, age in years and age groups, successful removal, mortality, history of FB aspiration, cough, wheezing, choking, stridor, reduced air entry and location of FB. Age in years was numeric, age groups ordinal and all other variables were on nominal scale. Age in years was described by mean & SD and others by count and percentage. Results: The sample with suspected foreign body aspiration (n=105) included 61 (58.1%) boys and 44 (41.9%) girls, with 20 (19.05%) in age group 0-2.0 years, 58 (55.24%) 2.0-5.0 years and 27 (25.71%) 5.0-14 years. Chest X-Ray was done in 98/105 (93.33%) cases. Frequency of successful FB removal by rigid bronchoscopy was 86/105 (81.90%). Mortality was none. Out of 86 confirmed cases, 51 (59.30%) were boys and 35 (40.70%) girls, with 19 (22.10%) in age group 0-2.0 years, 55 (63.95%) 2.0-5.0 years and 12 (13.95%) 5.0-14 years. Mean age was 3.57±1.78. History of FB aspiration was in 75/86 (87.21%), cough 65 (75.58%), stridor 14 (16.28%), wheezing 54 (62.79%) and choking 28 (32.56%) cases. Reduced air entry was 44 (51.16%) on right side, 17 (19.77%) on left side and 25 (29.05%) bilateral. Location of FB was larynx 6 (9.98%), trachea 20 (23.26%), right bronchus 44 (51.16%) and left bronchus 16 (18.60%). Conclusions: Foreign body aspiration in children in not an uncommon event. The parents should try to prevent such event, and if there, should present the child to emergency department of a hospital. ENT surgeons are supposed to evaluate and plan an earlier intervention as rigid bronchoscopy for these children.

scholarly journals Extraction of an Impacted Foreign Body Bronchus in an Adult Using Flexible Bronchoscopy

2021 ◽  
Author(s):  
Chandramouli M. T. ◽  
Nandakishore Baikunje ◽  
Rajesh Venkataram ◽  
Giridhar Hosmane
Keyword(s):  
Foreign Body ◽  
Main Bronchus ◽  
Balloon Catheter ◽  
Upper Airway ◽  
Clinical History ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Foreign Body Bronchus ◽  
Impacted Foreign Body ◽  
High Index Of Suspicion

AbstractForeign body aspiration (FBA) can be potentially fatal if the object is large enough to cause nearly complete obstruction of the upper airway. The object causing obstruction beyond the carina can result in less severe clinical presentation. FBA is rare in adults than in children. If the clinical history is not suggestive of FBA, then a high index of suspicion and flexible bronchoscopy can ensure proper diagnosis and prompt intervention. We present a case of an adult with aspirated betel nut in the left main bronchus, removed using flexible bronchoscopy with the aid of a Fogarty balloon catheter following the failure of rigid bronchoscopy.

Safely Decreasing Rigid Bronchoscopies for Foreign-Body Aspiration in Children: An Algorithm for the Emergency Department

2017 ◽  
Vol 28 (03) ◽  
pp. 273-278 ◽  
Author(s):  
Layla Haller ◽  
Constance Barazzone-Argiroffo ◽  
Isabelle Vidal ◽  
Regula Corbelli ◽  
Mehrak Anooshiravani-Dumont ◽  
...  
Keyword(s):  
Foreign Body ◽  
Clinical Signs ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Flexible Bronchoscopy ◽  
Current Management ◽  
Medical Chart Review ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Almost All

Introduction Rigid bronchoscopy was traditionally performed in the management of foreign-body aspiration (FBA). More recently, since development of a less invasive method, flexible bronchoscopy has been proposed in some centers for the management of FBA. For the past few years, we have applied a decisional algorithm, privileging flexible bronchoscopy for diagnosis and, in some cases, for extraction of foreign body (FB). Our aims are first to analyze our current management of FBA and second to examine the bronchoscopic findings and complications. Materials and Methods Retrospective medical chart review of all patients with clinical suspicion of FBA who underwent bronchoscopy (flexible and/or rigid) from 2009 through 2014. Results An FB was found in 23 (33%) of the 70 patients included in the study (45 boys, 25 girls; median age: 21.5 months). Diagnosis of FBA was made on first intention in 22/23 (96%) and extraction was performed in 7/23 (30%) by flexible bronchoscopy. Rigid bronchoscopy was necessary for the extraction of the 16/23 (70%) remaining FBs. The rigid procedure was performed as first intention in only two (3%) patients, and one of the two was negative. Among the clinical signs of FBA, none were > 90% specific except for apnea (100%), but which was poorly sensitive (22%). Seven clinical and radiologic signs were found to be significantly different between FB+ and FB− groups: sudden choking, cyanosis, apnea, decreased breath sounds, atelectasis, mediastinal shift, and air trapping. Conversely, when none of these symptoms or signs and no clear history of sudden choking were present (in 15/70 patients), no FB was found. No life-threatening complications or death were observed. Conclusion Our current management of FBA allows us to avoid almost all negative rigid bronchoscopies. In addition, we identified some symptoms and clinical and radiologic signs whose absence was highly predictive of negative bronchoscopy. We propose a novel algorithm for management of FBA that will help decrease the number of negative bronchoscopies.

scholarly journals Flexible Bronchoscopic Removal of Push-Pin from Right Lower Lobe Bronchus: a Case Report

2020 ◽  
Vol 3 (1) ◽  
pp. 323-325
Author(s):  
Prajwol Shrestha ◽  
Ashesh Dhungana ◽  
Madhusudan Kayastha ◽  
Manisha Shrestha ◽  
Deepa Niroula
Keyword(s):  
Foreign Body ◽  
Lower Lobe ◽  
Oral Route ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Flexible Bronchoscopy ◽  
Lobe Bronchus ◽  
Foreign Body Extraction ◽  
History Of ◽  
The Right

Foreign body aspiration is common in children and adolescents. Foreign body aspiration is often unnoticed and diagnosis may be delayed in children, as many fail to provide a history. Although rigid bronchoscopy is preferred modality, flexible bronchoscopy is also a useful tool for foreign body extraction from the distal airways in selected cases. An eleven-year-old boy presented with a history of fever and dry cough of one month's duration. A chest x-ray showed a linear radiopaque foreign body along the course of the right bronchus. Flexible bronchoscopy revealed a metallic nail-like structure in right lower lobe bronchus which was successfully grasped with the flexible forceps and extracted via the oral route with the bronchoscope. Upon extraction aspirated foreign body was found to be a push-pin.

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