Management of Respiratory Foreign Body- A Twelve Years Experience with 382 Cases

Objectives: To evaluate the clinico-demographic profile and management of foreign body (FB) aspiration in hospitalized patients. Methodology: This was a retrospective study conducted at the National Institute of Diseases of the Chest and Heart (NIDCH), Dhaka during the period of October 1994 to February 2006. Medical records were used for collection of cases. The diagnosis of FB aspiration was made from documented presenting features, physical findings, investigations of chest radiology, CT scan whenever done and management outcome with rigid bronchoscopy and surgical interventions like bronchotomy or resection surgery. Results: Most of the patients 374 (97.5%) were children up to 15 years of age with the peak age of 1-10 years (81.3%). Males were affected more (63%) than females (37%). The majority of the patients (96%) were from poor socio-economic status. Most of the patients 297 (77.7%) presented early (within 7 days of aspiration) with cough and respiratory distress. There was late (after 7 days up to 12 years) presentation in 85 (22.2%) cases with respiratory complications. FB was found to be radio-opaque in 122 (31.9%) cases on chest imaging. Rigid bronchoscopy was attempted in all cases initially and it was successful to remove FB in 99.6% cases in patients who presented early. But it failed to remove the FB in 49 (57.6%) of cases when the patients presented late. Most of the FBs were of natural in origin 247 (64.6%) and the number of artificial FBs was less 135 (35.3%). FBs found impacted more on the right bronchial tree in 230 (60.2%), followed by left side in 121 (31.6%) and central airway in 31 (8.1%) cases. In failed cases, bronchotomy, lobectomy and pneumonectomy were the other modalities (57.6%) of management. Conclusion: Children of the age group 1-10 years were found most vulnerable for FB aspiration. FB of natural origin were common in our situation. FBs were impacted mostly on the right side. Removal of FB by rigid bronchoscopy was excellent when the patients presented early. Other difficult modalities of management like bronchotomy, lobectomy and pneumonectomy were needed in cases of late presentation. DOI: 10.3329/bjch.v30i1.6177 Bangladesh J Child Health 2006; VOL 30 (1/2/3): 12-16

Download Full-text

Flexible bronchoscopy in foreign body removal in the pediatric population: A Systematic Review

10.22541/au.163675091.12588733/v1 ◽

2021 ◽

Author(s):

Anastasios-Panagiotis Chantzaras ◽

Panagiota Panagiotou ◽

Spyridon Karageorgos ◽

Konstantinos Douros

Keyword(s):

Systematic Review ◽

Foreign Body ◽

Pediatric Population ◽

Bronchial Tree ◽

Tracheobronchial Tree ◽

Flexible Bronchoscopy ◽

Safe Alternative ◽

Gold Standard Method ◽

Foreign Body Removal ◽

The Right

Background: Foreign body aspiration (FBA) in the tracheobronchial tree is a common problem in the pediatric population. Rigid bronchoscopic procedure is currently the gold standard method for treatment in pediatric patients, whereas recent reports present flexible bronchoscopy as an alternative method. The aim of this study was to summarize all available evidence regarding the application and the success rate of flexible bronchoscopy in foreign body (FB) removal. Methods: Systematic review of the use of flexible bronchoscopy as the first-line treatment in FBA cases in PubMed from 2001 to 2021. Results: Out of 243 citations, 23 studies were included on the use of flexible bronchoscopic procedure as a treatment of choice in 2,587 children with FBA. The FBs were successfully removed in 2,254/2,587 (87.1%) patients with a low complication rate. The majority of FBs retrieved were organic materials 1,073/1,370 (78.3%), and they were most commonly lodged in the right bronchial tree 708/1,401 (50.5%). General anesthesia was applied in most studies (14/23) before proceeding to a flexible bronchoscopy and laryngeal mask airways (LMAs) were mostly used (10/23 studies) to secure the airway during the procedure. Ancillary equipment, usually forceps 1,544/1808 (85.4%) assisted in the FB retrieval. Conclusion: The use of flexible bronchoscopy is shown to be a feasible and safe alternative therapeutic procedure in FBA cases. There is a need for development of extraction equipment and techniques to assist the procedure. Finally, future studies focusing on the comparison between clinical outcomes of flexible and rigid bronchoscopies are necessary.

Download Full-text

Laryngo-tracheo-bronchial foreign bodies in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215100107170 ◽

1988 ◽

Vol 102 (11) ◽

pp. 1029-1032 ◽

Cited By ~ 78

Author(s):

Amit Banerjee ◽

K. S. V. K. Subba Rao ◽

S. K. Khanna ◽

P. S. Narayanant ◽

B. K. Gupta ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Bronchial Tree ◽

Endoscopic Removal ◽

Diagnosis And Management ◽

Respiratory Passage ◽

History Of ◽

The Right

AbstractInhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyze the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and fort eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.

Download Full-text

Utility of Flexible Bronchoscopy for Airway Foreign Bodies Removal in Adults

Journal of Clinical Medicine ◽

10.3390/jcm9051409 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1409 ◽

Cited By ~ 1

Author(s):

Jose N. Sancho-Chust ◽

Virginia Molina ◽

Sandra Vañes ◽

Ana M. Pulido ◽

Lia Maestre ◽

...

Keyword(s):

Foreign Bodies ◽

Clinical Presentation ◽

Demographic Data ◽

Bronchial Tree ◽

Rigid Bronchoscopy ◽

Flexible Bronchoscopy ◽

Rare Entity ◽

Radiological Findings ◽

Bronchial Infection ◽

The Right

Foreign body aspiration is relatively infrequent in adults. Airway foreign bodies (AFBs) can be removed by flexible bronchoscopy (FB) or rigid bronchoscopy (RB). We performed a retrospective analysis of FBs performed in our centre over a 25 year period, focusing on the procedures that revealed an AFB during the examination stage. We recorded demographic data, clinical characteristics and radiological and bronchoscopic findings. During the study period, 12,588 FBs were performed in adults. Airway foreign bodies were identified in 32 of these cases, giving a prevalence of 0.25%. The most frequent clinical presentation was cough, sputum and fever. The most frequent radiological findings were alveolar infiltrates and atelectasis. In 94% of cases, AFBs were removed successfully by FB; RB was necessary in only 6% of cases. There were no FB-related complications. The most common AFB location was the right bronchial tree (69%). We classified AFBs as organic (85%: animal 57%; vegetable 28%), inorganic (6%) and iatrogenic (9%). Bronchial infection occurred in 51% of cases, and Actinomyces spp. was the most common causal microorganism. In conclusion, AFBs are a rare entity with nonspecific clinical presentation, most AFBs were organic, and FB is a safe and effective method for AFB removal.

Download Full-text

Foreign body extraction through the rigid bronchoscopy

Vojnosanitetski pregled ◽

10.2298/vsp1110878m ◽

2011 ◽

Vol 68 (10) ◽

pp. 878-880 ◽

Cited By ~ 2

Author(s):

Stanko Mrvic ◽

Milos Milosavljevic ◽

Dragan Stojkovic ◽

Slobodan Milisavljevic ◽

Dragce Radovanovic ◽

...

Keyword(s):

Foreign Body ◽

Pediatric Population ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Middle Lobe ◽

Lobe Bronchus ◽

Segmental Bronchus ◽

Foreign Body Extraction ◽

The Right ◽

High Level

Introduction. Foreign body aspiration into tracheobronchial tree represents an urgent condition at high level of risk. Etiology is different, and this condition is typical for all ages with highest incidence in pediatric population. Case report. A successful foreign body removal (partial denture) in a 34-year old man was presented. Radiography and computerized tomography of the chest showed a foreign body localized at the level of the right bronchus including the right middle lobe bronchus. By the use of rigid bronchoscopy, a foreign body was visualized and mobilized from the segmental bronchus in the first act, and then completely extracted. Conclusion. Efficient diagnostics and extraction are imperative for the aspirated foreign body preventing life-threatening complications.

Download Full-text

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.

Download Full-text

Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

Case Reports in Pulmonology ◽

10.1155/2014/465856 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ataman Köse ◽

Dilek Kostak ◽

Erol Aramagan ◽

Aslıhan Durak ◽

Nur Sezin Seçkin ◽

...

Keyword(s):

Foreign Body ◽

Signs And Symptoms ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Dental Prosthesis ◽

Tracheobronchial Foreign Body ◽

Bronchial System ◽

Foreign Materials ◽

Dental Apparatus ◽

The Right

It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

Download Full-text

Suspecting Airway Foreign Body in Agenesis of the Lung: A Rare Incidence of Misdiagnosis

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1100 ◽

2015 ◽

Vol 5 (1) ◽

pp. 32-34

Author(s):

Mahesh Chandra Sahu ◽

Sidarth Mohanty ◽

Jashashree Choudhury

Keyword(s):

Foreign Body ◽

Ct Scan ◽

Rare Condition ◽

Rigid Bronchoscopy ◽

Diagnostic Dilemma ◽

Contrast Enhanced Ct ◽

Chest X Ray ◽

Airway Foreign Body ◽

The Right ◽

The Mind

ABSTRACT Agenesis of the lung is an extremely rare condition. Suspecting foreign body in agenesis of the lung is a diagnostic dilemma. We report the case of an 11 months old boy who presented with cough and cold; examination showed decreased air entry on the right side and investigations reported collapse on chest X-ray and plain computed tomography (CT) scan of thorax. Pediatrician suspected airway foreign body. Rigid bronchoscopy was done to confirm the diagnosis, but there was blind end in the right bronchus with no foreign body seen. Contrast-enhanced CT scan (CECT) of the neck and chest confirmed the aplasia of right lung. Agenesis of the lung should be kept in the mind by the clinician when dealing with foreign body in airway. This can prevent unnecessary intervention like rigid bronchoscopy. How to cite this article Swain SK, Mohanty S, Singh N, Choudhury J, Sahu MC. Suspecting Airway Foreign Body in Agenesis of the Lung: A Rare Incidence of Misdiagnosis. Int J Phonosurg Laryngol 2015;5(1):32-34.

Download Full-text

Komplikasi Kronik Benda Asing Pada Percabangan Bronkus

Jurnal Ilmu Kesehatan Indonesia ◽

10.25077/jikesi.v1i2.26 ◽

2020 ◽

Vol 1 (2) ◽

Author(s):

Russilawati Russilawati

Keyword(s):

Foreign Body ◽

Lower Lobe ◽

Recurrent Infection ◽

Major Complication ◽

Bronchial Tree ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Small Object ◽

Chronic Complication ◽

Life Threatening

CHRONIC COMPLICATION OF FOREIGN BODY IN TRACHEOBRONCHIAL TREE : A CASE REPORT Foreign body aspiration in tracheobronchial could be life threatening particularly if the object large enought to cause nearly complete obstruction. In the other hand small object could pass beyond carina and cause less severe sign and complication manifest. Chronic symptoms with recurrent infection that lead to brochiectasis may occur in delayed of extraction. We presented a case of nail aspiration by a 17 years old male patients who presented with hemoptysis. The patient had history of nail aspiration six months ago and had no symptom until the last one week . First attempt of evacuating used rigid bronchoscopy under general anesthesia had failed. Fiber optic bronchoscopy (FOB) found the nail at the orificium of right lower lobe and chest computed tomography stated the occurancy of bronchiectasis at distal of nail. The extraction was performed by FOB with local anesthesia succeeded to remove the nail to the laring that induced cough and nail threw out. There were no major complication and further symptoms after the extraction. Eventhough aspiration small object cause no symptom, it could lead to chronic complication such as bronchiectasis. FOB for removing the object is supposed to perform carefully because the object could fall on another part of brochial tree when it was pulled out. Keywords Foreign Body, Bronchial tree, complication, flexible bronchoscopy

Download Full-text

Our Anesthesia Experiences in the Tracheobronchial Foreign Body Aspirations of Pediatric Patients During Rigid Bronchoscopy

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.31032 ◽

2021 ◽

Author(s):

Yiğit Şahin ◽

Tülay Çardaközü ◽

Hüseyin Fatih Sezer

Keyword(s):

Foreign Body ◽

General Anesthesia ◽

Similar Rate ◽

Rigid Bronchoscopy ◽

Muscle Relaxants ◽

Foreign Body Aspiration ◽

Anesthesia Induction ◽

Inhalation Anesthetics ◽

Tracheobronchial Foreign Body ◽

The Right

Objective: Bronchoscopy is the gold standard in the diagnosis and treatment of tracheobronchial foreign body aspiration (TBFBA) in children. Rigid bronchoscopy (RB) under general anesthesia is generally preferred in children. In this article, our anesthesia experiences during rigid bronchoscopy performed for tracheobronchial foreign body aspiration and removal of foreign bodies in children are shared. Methods: The medical records of all patients aged between 0-18 years who underwent RB under general anesthesia due to suspicion of TBFBA between January 1, 2014 and December 31, 2018 were retrospectively analyzed. Results: TBFBA was more common in boys and organic foreign body aspiration was significantly higher in patients between 13-36 months of age. Patients most frequently presented with cough and wheezing. Most of them were operated between 8 am and 4 pm. TFBs were localized in the right and left main bronchi at a similar rate. Anesthesia induction was usually achieved with iv. propofol, total intravenous anesthesia and sevoflurane inhalation was administered for maintenance of anesthesia. Except for proximally located TBFBs, intermediate-or short-acting muscle relaxants were applied to most of the cases depending on the duration of the procedure. Three patients were intubated postoperatively and transferred to intensive care unit. Respiratory distress responded to medical treatment in 25 patients. No cardiac arrest or death occurred during the procedure. Conclusion: RB and anesthesia procedure for TBYCA requires experience. There is no clear recommendation about premedication, the use of muscle relaxants should be evaluated according to the localization of TBYC. In anesthesia management, intravenous or inhalation anesthetics can be used.

Download Full-text

Inhaled foreign bodies in adolescents and adults

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2005.620 ◽

2005 ◽

Vol 63 (4) ◽

Cited By ~ 10

Author(s):

S.M. Tariq ◽

J. George ◽

S. Srinivasan

Keyword(s):

Foreign Body ◽

Older Patients ◽

Foreign Bodies ◽

Late Presentation ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Pulmonary Complications ◽

Adolescents And Adults ◽

Food Particles ◽

Foreign Body Inhalation

Background. Accidental foreign body inhalation is not uncommon. The incidence is high in children, especially the very young ones. We evaluated the management of inhaled foreign bodies in an adult respiratory medical unit, highlighting circumstances leading to inhalation, associated complications and difficulties encountered at bronchoscopic retrieval. Methods. We reviewed all cases of inhaled foreign bodies presenting over a period of 12 years (1991-2003). Results. 5 of 8 cases were teenagers whereas 3 were aged over 55 years. The older patients had co-morbidities and had aspirated food particles. In 2 cases, a bronchoscopy was performed primarily to exclude lung cancer, and the discovery of a foreign body was a surprise. Pulmonary complications related to foreign body inhalation were common among this group. All 5 teenage patients presented after inhalation of small objects. 4 patients from the teenage group had general anaesthesia; in 2 of them a laryngeal mask airway was employed, whilst 2 had endotracheal intubation. Only one patient was given a rigid bronchoscopy following failure of the fiberoptic instrument. Difficulties at retrieval of foreign body were frequently encountered. Conclusions. In the adolescent and adult patients, most inhaled foreign bodies are retrievable by flexible bronchoscopy. However, facilities for rigid bronchoscopy should be available as a back-up. Pulmonary complications are common after foreign body inhalation especially in the older patients. Difficulties at bronchoscopic removal may occur due to late presentation or to the site and/or position of the foreign body within the tracheobronchial tree.

Download Full-text