Inhaled foreign bodies in adolescents and adults

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.

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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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Foreign Body Removal: A New Role for the Fiberoptic Bronchoscope

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947508400516 ◽

1975 ◽

Vol 84 (5) ◽

pp. 650-656 ◽

Cited By ~ 20

Author(s):

Donald C. Zavala ◽

Mitchell L. Rhodes

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Balloon Catheter ◽

Small Diameter ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Fiberoptic Bronchoscope ◽

Older Children ◽

Foreign Body Removal ◽

The Wire

Artificial and animal lung models initially were used to investigate the removal of foreign bodies from the tracheobronchial tree with the flexible fiberoptic bronchoscope. Different extraction instruments (claw, basket, forceps, and balloon catheter) were passed separately through the channel of the bronchofiberscope, and tested for usefulness prior to human application. The Fogarty balloon catheter served as a valuable aid in dislodging impacted objects so that the operator could then grasp them with the claw, basket or forceps. The wire claw recovered many of the metallic and organic objects, the wire basket was successful in retrieving only the bulky objects and the forceps (ACMI) was effective in capturing all of the metallic foreign bodies. These techniques, developed in our laboratory, are now being used to augment rigid bronchoscopy in the removal of foreign bodies from adults and older children. At the present time fiberoptic foreign body removal is not recommended for pediatric cases because of the small diameter of the trachea and glottis in infants and young children.

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Grassheads in the Tracheobronchial Tree: Two Different Outcomes

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000425 ◽

1981 ◽

Vol 90 (4) ◽

pp. 406-408 ◽

Cited By ~ 4

Author(s):

Mary J. Spencer ◽

Victoria E. Millet ◽

James P. Dudley ◽

Jessie L. Sherrod ◽

Yvonne J. Bryson

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Clinical Course ◽

Lower Lobe ◽

Tracheobronchial Tree ◽

Pulmonary Complications ◽

Essential Factor ◽

Chemical Irritation ◽

The Difference ◽

The Right

Many vegetable foreign bodies can produce serious pulmonary complications because of chemical irritation to the airway. Barley grass, a type of grasshead, does not induce such a reaction because of its resistance to organic decay. Complications which may occur are illustrated by the clinical course of two patients with aspiration of this foreign body. In the first patient the grasshead entered the trachea with the flowering unit first and the stem following. In the second patient the stem entered the trachea first. Recurrent pneumonias were noted in the first patient. Despite its presence in the right stem bronchus for three years, no further episodes of pneumonia followed its removal. In the second patient the grassheads could not be removed endoscopically. They migrated into the right lower lobe producing pneumonia and ultimately resulting in a brain abscess. The difference of entry of the same foreign body into the trachea, stem first versus flowering unit first, is an essential factor in altering the clinical outcome.

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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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Foreign Bodies of the Lower Airway: Sunflower Seed Alert!

PEDIATRICS ◽

10.1542/peds.95.6.959 ◽

1995 ◽

Vol 95 (6) ◽

pp. 959-959

Author(s):

Glenn Isaacson

Keyword(s):

Foreign Body ◽

Sunflower Seed ◽

Foreign Bodies ◽

Tracheobronchial Tree ◽

Lower Airway ◽

Sunflower Seeds ◽

Remarkable Change ◽

Detailed List

Jackson and Jackson,1 in their landmark text, describe over 3000 foreign bodies of the air and food passages removed during their careers. Of these, 565 were vegetative and from the tracheobronchial tree. In their detailed list of foreign body types, sunflower seeds are not mentioned. A review of airway foreign bodies removed from children in the last 4 years at St. Christopher's Hospital for Children, the Jacksons' main operative hospital for children, showed a remarkable change.

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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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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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Pediatric rigid bronchoscopy and foreign body removal during the COVID-19 pandemic: case report

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00464-z ◽

2020 ◽

Vol 49 (1) ◽

Author(s):

Darren Jonathan Leitao ◽

Jodi L. P. Jones

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Rigid Bronchoscopy ◽

Lessons Learned ◽

Surgical Time ◽

Foreign Body Removal ◽

Care Workers ◽

Operative Planning ◽

Set Up ◽

N95 Respirators

Abstract We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered.

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Complications Associated with 327 Foreign Bodies of the Pharynx, Larynx, and Esophagus

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600407 ◽

1997 ◽

Vol 106 (4) ◽

pp. 301-304 ◽

Cited By ~ 93

Author(s):

Bhuvanesh Singh ◽

Gady Har-El ◽

Manoj Kantu ◽

Frank E. Lucente

Keyword(s):

Older Patients ◽

Foreign Bodies ◽

Care Center ◽

Tertiary Care ◽

Significant Risk ◽

Perioperative Period ◽

Pulmonary Complications ◽

Retropharyngeal Abscess ◽

Delayed Presentation ◽

Upper Aerodigestive Tract

We intended to identify the types and incidence of complications associated with foreign bodies (FBs) impacted in the upper aerodigestive tract (UADT) and to ascertain factors predisposing to the development of these complications. The design was a retrospective cohort study of 327 patients with UADT foreign bodies admitted to a tertiary care center. The overall incidence (7.6%) and types of complications varied by age. Complications developed in 4.8% of 208 patients 10 years of age and under, with pulmonary complications being most common. In contrast, complications occurred in 12.6% of 119 older patients, with retropharyngeal abscess being the most common (p < .0001). Delayed presentation (>24 hours after the onset of symptoms) was the only factor associated with an increase in the incidence of complications in the younger patients (p = .02). In contrast, pharyngeal location of the FB (p = .0004), the FB's being a fish bone (p = .006), and radiolucency (p = .02) were all associated with an increased incidence of complications in patients over 10 years of age. A significant risk for complications is present for patients admitted for the management of FBs in the UADT. Older patients with sharp FBs are at greatest risk. In this group of patients, close observation in the perioperative period is required, especially if there is evidence of mucosal injury.

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