FOREIGN BODY BRONCHUS PRESENTING WITH PLEURAL EFFUSION –A RARE PRESENTATION

INTRODUCTION: Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe. Aspiration has been documented in all lobes, including the upper lobes, though with less frequency.1-4 CASE REPORT: A 28 year old female presented with the chief complaints of shortness of breath since 15 days, cough with expectoration since 15 days, chest pain since 15 days. On examination the trachea was shifted to left side, bilateral chest movements were unequal with reduced chest movement on right side, tenderness was present on right side of chest. Chest X-Ray showed right sided hydropneumothorax. On flexible bronchoscopy Right bronchus intermedius showed foreign material. Foreign body removal under general anesthesia was done by rigid bronchoscopy. DISCUSSION: Unlike foreign-body aspiration in young children and in the elderly, this occurence is uncommon in adults. The availability of both rigid and flexible bronchoscopy should be emphasized since larger aspirates may not be retrievable with a flexible bronchoscope. Surgery constitutes the final, definitive option and is generally well tolerated, particularly when the lung parenchyma is spared.5-7 This case emphasizes the fact that healthy adults may tolerate aspiration of foreign bodies for a long time without acute life-threatening consequences.5-8 The exact mechanism is not known. The possible mechanisms are either it may be a result of an inflammatory response to a foreign body in the bronchus or it is secondary to the atelectasis and the sudden morenegative intrathoracic pressure.9-11

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Tracheobronchial foreign body aspiration in children aged ≤ 2 years: the use of ﬂexible bronchoscopy and urology stone retrieval basket in emergency setting

10.22514/sv.2021.014 ◽

2021 ◽

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Main Bronchus ◽

Pediatric Population ◽

Operation Time ◽

Operative Management ◽

Flexible Bronchoscopy ◽

Emergency Setting ◽

Flexible Bronchoscope ◽

Pediatric Airway

Objective: Tracheobronchial aspiration of foreign body in children is an emergency that can lead to major complications. In the last years flexible bronchoscopy has gained popularity for foreign bodies retrieval in the pediatric population, yet the small size of the pediatric airway and of the flexible bronchoscope channel limit the availability of instruments during the procedure. Aim of this paper is to describe our experience in treating foreign bodies tracheobronchial aspiration in children aged 2 years or less by means of flexible bronchoscope and an urology stone retrieval basket. Methods: A review of endoscopic foreign bodies removal by means of flexible bronchoscopy and urology stone retrieval basket has been carried out in children ≤ 2 years that presented at the Emergency Room of our hospital from 2005 to 2019. In the paper, we analyze characteristics of patients, timing of bronchoscopy, instruments and operative management. Results: There were 25 patients with a mean age of 20 ± 3.8 months. Organic material was the most frequent observed foreign body. Association of main bronchus and distal bronchi was the preferred site of the foreign body in 19 patients and the right side of the bronchial tree was involved in 17 cases. Complications occurred in one case. Mean operation time was 37 ± 20 minutes. Conclusions: The use of flexible bronchoscope can be helpful in handling endoscopic removal of tracheobronchial foreign bodies in toddlers. The use of the urology stone retrieval basket resulted very effective in all shapes of foreign bodies and/or when the object was located in the distal bronchi.

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

Nepalese Medical Journal ◽

10.3126/nmj.v3i1.28613 ◽

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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Case Report: Diagnosis and Management of Pin-Headscarf at The Bronchial Segment In RSUP Dr. M Djamil Padang

Journal of Agromedicine and Medical Sciences ◽

10.19184/ams.v7i3.24494 ◽

2021 ◽

Vol 7 (3) ◽

pp. 125

Author(s):

Wahyu Julianda ◽

Ade Asyari

Keyword(s):

Case Report ◽

Foreign Body ◽

Thoracic Surgery ◽

Foreign Bodies ◽

Lower Lobe ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

X Ray ◽

Video Assisted Thoracic Surgery ◽

Chest X Ray

Introduction: Foreign body aspiration into the airway is a common case in children. Scarf pin aspiration often occurs in women who wear the hijab. A bronchoscopy is an option in the management of foreign body aspiration cases. However, other treatments such as thoracotomy can be considered, if the management of foreign body aspiration fails using rigid bronchoscopy. Case Report: Reported one case of a 12-year-old girl who complained of inhaling scarf pin 1 day before being admitted to hospital. Chest X-ray found radiopaque foreign body projection as high as spatium intercostal V with right lower lobe projection. The patient was diagnosed with foreign body pin scarf et right bronchus and was treated with a rigid bronchoscopy but it was not successfully extracted, one and a half months later the patient was performed Video-assisted thoracic surgery but failed to re-extract, then the foreign bodies were successfully extracted after the thoracotomy. Conclusion: Migration of pins into the bronchial segments as high as spatium intercostal V projections right lower lobe and left lower lobe will be difficult to locate and extract with rigid bronchoscopy. Thoracotomy is further management for scarf pin aspiration that fails to be treated by rigid bronchoscopy. Keywords: foreign body, scarf pin, bronchoscopy, segment bronchi, thoracotomy

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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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Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

10.21203/rs.3.rs-41995/v3 ◽

2020 ◽

Author(s):

Bo Liu ◽

Fengxia Ding ◽

Yong An ◽

Yonggang Li ◽

Zhengxia Pan ◽

...

Keyword(s):

Foreign Body ◽

Medical Records ◽

Foreign Bodies ◽

Pediatric Patients ◽

Previous History ◽

Rigid Bronchoscopy ◽

Diagnostic Difficulties ◽

History Of ◽

Male Patients ◽

Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

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

10.21203/rs.2.11329/v1 ◽

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.

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Denture Impaction Causing an Upper Esophageal Diverticulum

Case Reports in Gastrointestinal Medicine ◽

10.1155/2019/9621383 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Shireen Samargandy ◽

Hani Marzouki ◽

Talal Al-Khatib ◽

Mazin Merdad

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

The Elderly ◽

Barium Swallow ◽

Diagnostic Challenge ◽

Case Presentation ◽

History Of ◽

Endoscopic Diverticulotomy ◽

Tomography Scan ◽

Rule Out

Background. Dentures are a common cause of inadvertent foreign body ingestion particularly in the elderly. Due to their radiolucent nature, they often present a diagnostic challenge to care providing physicians. Case Presentation. A 66-year-old female presented to our otolaryngology clinic with a 2-year history of dysphagia. Her physical examination was unremarkable. Computed tomography scan of the neck and barium swallow suggested Zenker diverticulum. She was planned for endoscopic diverticulotomy; however, during surgery, a foreign body was incidentally found and retrieved, which was a partial lower denture. The diverticulum resolved thereafter, and the patient's symptoms abated. Conclusion. The authors recommend evaluating the esophagus endoscopically first in cases of upper esophageal diverticular formation, even when planning an open repair approach, to rule out any concealed foreign bodies.

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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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Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194925 ◽

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

Background: The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.Methods: 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. Results: 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.Conclusions: 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.

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VATS-resection of the lower lobe of the left lung as a result of treatment of the long-term consequences of postponed foreign body aspiration in the child’s airways: Clinical case

Paediatric Surgery Ukraine ◽

10.15574/ps.2020.69.90 ◽

2020 ◽

pp. 90-95

Author(s):

M. Opanasenko ◽

◽

L. Levanda ◽

A. Tereshkovich ◽

I. Liskina ◽

...

Keyword(s):

Foreign Body ◽

Respiratory Tract ◽

Clinical Case ◽

Foreign Bodies ◽

Correct Diagnosis ◽

Left Lung ◽

Lower Lobe ◽

Physical Exertion ◽

Recurrent Pneumonia ◽

The Right

Introduction. Foreign bodies in the airways are a very urgent problem that occurs at any age and quite often requires an urgent and sometimes urgent assessment of the situation, examination, and making the right decision. According to statistics, most often foreign body in airway are found in childhood. In about 95–98% of cases, this pathology is recorded in children aged 1.5 to 3 years. This is due to the behavior of children, their anatomical and physiological characteristics and underdevelopment of protective reflexes. Among all cases of foreign body in airway, foreign bodies of the larynx are found in 12%, trachea – in 18%, bronchus – in 70% of cases. In 80% of cases, CTs enter the right bronchus, as it is a broader and more direct continuation of the trachea. The correct diagnosis is established early after CT aspiration in 40–57% of patients. The mortality rate varies, according to different authors, from 2 to 15%. Clinical case. The boy V., born in 2008. was admitted to the Department of Pediatric Pulmonology on May 30, 2019, with complaints of frequent unproductive cough, mainly daytime, increasing with physical exertion, sometimes subfibril body temperature, weakness, lethargy, decrease appetite. These complaints have been observed for the third time in the last six months. Diagnosis: Foreign body B10 of the left lung. Conclusions. Aspiration of a foreign body into the respiratory tract most often occurs in early childhood (1–3 years). The clinical picture in the early stages is asymptomatic, and over time it leads to the development of inflammatory changes in the lungs, are treated conservatively. Given the complexity of diagnosis, aspiration of a foreign body can lead to frequent recurrent pneumonia, the formation of bronchiectasis in the lower parts of the lungs, which may require surgical treatment. The gold standard of diagnostics is fibrobronchoscopy and spiral computed tomography of the thoracic cavity (SCT OGK), with the help of which, early after aspiration, a foreign body can be detected and subsequently excluded from the respiratory tract. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution.The informed consent of the child’s parents was obtained from the studies. No conflict of interest was declared by the authors. Key words: child, lungs, foreign body.

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