Utility of Flexible Bronchoscopy for Airway Foreign Bodies Removal in Adults

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.

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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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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.

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A rare cause of right iliac fossa lump: contained fish bone perforation of caecum

International Surgery Journal ◽

10.18203/2349-2902.isj20204161 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3476

Author(s):

Washim F. Khan ◽

Sandeep Jain ◽

Yashwant S. Rathore ◽

Sunil Chumber

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Iliac Fossa ◽

Exploratory Laparotomy ◽

Right Hemicolectomy ◽

Fish Bone ◽

Rare Entity ◽

Radiological Findings ◽

Generalized Peritonitis ◽

High Index Of Suspicion

Ingested foreign bodies usually pass uneventfully through the gastrointestinal tract but few of them can cause symptoms. They can get stuck at acute angulations or narrow part of intestine and can perforate leading to localized to generalized peritonitis, collection or abscess formation. We describe a case of 59 year old gentleman who presented with pain in right iliac fossa with fever and a hard, tender lump. Initial investigation revealed a mass in right iliac fossa adherent to anterior abdominal was in right iliac fossa region with a foreign body inside. Patient was managed with exploratory laparotomy, removal of a fish bone from cacecum and limited right hemicolectomy. Fishbone perforation of caecum is a rare entity. Careful corroboration between patient’s presentation and radiological findings with a high index of suspicion is needed for pre-operative diagnosis.

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Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis

BMC Neurology ◽

10.1186/s12883-020-01944-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Vetrivel Muralidharan ◽

Gaetano Failla ◽

Mario Travali ◽

Tiziana Liliana Cavallaro ◽

Marco Angelo Politi

Keyword(s):

Clinical Presentation ◽

Subcortical White Matter ◽

Digital Subtraction ◽

Resonance Imaging ◽

Radiological Findings ◽

Hyperintense Signal ◽

Right Cerebral Hemisphere ◽

Weber Syndrome ◽

Sturge Weber Syndrome ◽

The Right

Abstract Background Sturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge. Case presentation We report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy. Conclusion Conglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.

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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.

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Intracranial Ewing Sarcoma – A case report

Surgical Neurology International ◽

10.25259/sni_178_2020 ◽

2020 ◽

Vol 11 ◽

pp. 134

Author(s):

Jiahua Huang ◽

Finn Ghent ◽

Robyn Levingston ◽

Martin Scholsem

Keyword(s):

Adjuvant Chemotherapy ◽

Clinical Presentation ◽

Treatment Protocol ◽

Rare Entity ◽

Round Cell ◽

Peripheral Primitive Neuroectodermal Tumor ◽

Radiological Findings ◽

Adjuvant Chemoradiation ◽

Total Resection ◽

Mri Brain

Background: Intracranial Ewing’s sarcoma (ES) is a rare entity with <15 cases reported in the literature. It belongs to a family of round-cell neuroectodermally derived tumors bearing many similarities to peripheral primitive neuroectodermal tumor (pPNET). There is currently no established treatment protocol. Reported cases are treated with either surgery alone or surgery with adjuvant chemotherapy and radiation. Case Description: We describe a case of intracranial left frontal ES in a 19-year-old patient who presented with change in behavior. Diagnosis was unclear based on radiological findings on MRI and CT alone. MRI brain with contrast demonstrated a large extra-axial ovoid heterogeneously enhancing left frontal convexity mass. The patient underwent gross total resection with adjuvant chemotherapy and radiation. No local or systemic recurrence was found at 12 months postoperatively. Conclusion: Intracranial ES/pPNET is rare tumor with nonspecific clinical presentation and radiological findings. They are locally invasive. Surgery with adjuvant chemoradiation is the mainstay treatment. Distinction of pPNET and cPNET is important for therapeutic and prognostic purposes.

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Tracheobronchial foreign bodies in cats: a retrospective study of 12 cases

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x15615657 ◽

2016 ◽

Vol 19 (2) ◽

pp. 117-122 ◽

Cited By ~ 4

Author(s):

Rodolfo Oliveira Leal ◽

Yannick Bongrand ◽

Julie Gallay Lepoutre ◽

Eymeric Gomes ◽

Juan Hernandez

Keyword(s):

Retrospective Study ◽

Surgical Approach ◽

Foreign Bodies ◽

Clinical Signs ◽

Diagnostic Procedures ◽

Bronchial Tree ◽

Private Practices ◽

Main Complaint ◽

The Right ◽

Method Of Extraction

Objectives The aim of the study was to evaluate age, sex, breed, clinical signs, time between onset of signs and presentation, diagnostic procedures, method of extraction, location and nature of foreign bodies (FBs) in confirmed cases of tracheobronchial FBs in cats. We hypothesised that bronchoscopy was effective in extracting tracheobronchial FBs in cats. Methods A retrospective study was performed using clinical reports from three private practices in France between May 2009 and November 2014. Cats were included if an intraluminal tracheobronchial FB had been identified and extracted (either by bronchoscopy or surgery). Results Twelve cats (six male, six female) were included. Mean age was 3.75 ± 2.5 years. Coughing was the main complaint and was present in 9/12 (75%) of the cats. Thoracic radiographs were obtained in 12/12 cats (100%) and a FB was suspected in 11/12 (92%). Bronchoscopy was performed in all of the cats and enabled FB extraction in 10/12 (83%) of them. In 2/12 cats (17%), an additional surgical approach was required. In 6/12 (50%) cats, FBs were located in the trachea, while in 6/12 (50%) cats FBs were in the bronchial tree, particularly in the right caudal bronchus (4/6; 66%). Seven of 12 (58%) FBs were vegetal in nature, 3/12 (25%) were mineral and 2/12 (17%) were undetermined. All the mineral FBs were extracted from the trachea, while the majority of the vegetal ones (5/7; 71%) were found in the bronchi. Conclusions and relevance Feline respiratory FBs can be found in the trachea and in the bronchial tree, particularly in the right caudal bronchus. Vegetal FBs tend to migrate through the bronchial tree, whereas mineral ones tend to lodge in the trachea. Bronchoscopy seems to be a highly effective procedure for the extraction of tracheobronchial FBs in cats.

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

Bangladesh Journal of Child Health ◽

10.3329/bjch.v30i1.6177 ◽

1970 ◽

pp. 12-16

Author(s):

Golam Mohiuddin Akbar Chowdhury ◽

AKM Akramul Haque ◽

Zillur Rahman ◽

ARM Luthful Kabir ◽

Ruhul Amin ◽

...

Keyword(s):

Foreign Body ◽

Economic Status ◽

Late Presentation ◽

Bronchial Tree ◽

Rigid Bronchoscopy ◽

Surgical Interventions ◽

Chest Radiology ◽

The Right ◽

Physical Findings ◽

Central Airway

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

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Chronic Intussusception Associated with Malrotation in a Child: A Variation of Waugh’s Syndrome?

Case Reports in Surgery ◽

10.1155/2016/5638451 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Nick Zavras ◽

Konstantinos Tsilikas ◽

George Vaos

Keyword(s):

Unusual Case ◽

Clinical Presentation ◽

Intestinal Malrotation ◽

Rare Entity ◽

Older Children ◽

Radiological Findings ◽

Uncommon Disease ◽

Chronic Intussusception

Chronic intussusception is a relatively uncommon disease most commonly observed in older children. Waugh’s syndrome represents a rare entity characterized by intestinal malrotation and acute intussusception. We report a very unusual case of intestinal malrotation associated with chronic intussusception. Clinical presentation, radiological findings, and managing of this association are discussed in the light of the available literature.

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Myxoid liposarcoma metastatic to the thyroid gland: a case report and literature review

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000867 ◽

2006 ◽

Vol 120 (6) ◽

pp. 511-513 ◽

Cited By ~ 11

Author(s):

J R Tysome ◽

A Sandison ◽

P M Clarke

Keyword(s):

Case Report ◽

Thyroid Gland ◽

Literature Review ◽

Clinical Presentation ◽

Myxoid Liposarcoma ◽

Good Prognosis ◽

Rare Entity ◽

The Right ◽

Patterns Of Recurrence

We present the second reported case of a myxoid liposarcoma metastatic to the thyroid gland in a 51-year-old gentleman with previous liposarcoma of the right thigh. Myxoid liposarcoma has a relatively good prognosis but tends to recur locally. Metastases affecting the thyroid gland are a rare entity and most commonly arise from the kidney, lung or breast. Clinical presentation, patterns of recurrence and prognosis of myxoid liposarcoma and metastases to the thyroid gland are discussed.

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