Bronchoscopic Extraction Research Articles

Flexible bronchoscopy-assisted removal of aspirated scarf pins from the tracheobronchial tree: the experience of 146 subjects.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

Different Modalities Used in the Art of Managing Tracheobronchial Foreign Bodies.

Foreign body aspiration is a commonly encountered and challenging emergency. Foreign body aspiration causes significant morbidity and mortality in the paediatric population. In adults, it is usually encountered in patients with impaired consciousness and in young females using pins to secure their veils. We aimed to analyse the incidence, type and site of foreign body, radiological presentation, complications and different modalities used in managing tracheobronchial foreign bodies (FBs). A prospective single centre cross-sectional study between December 2010 and December 2011 in the Department of Cardiothoracic Surgery at the University of Alexandria, Egypt. Seventy-eight patients were included. The age of the patients ranged between 1.3 and 32 years, with a mean of 13.37± 7.67 years. Inorganic FBs were the most common aspirated FBs (66 patients, 84.62%). FBs were more frequently located in the left versus the right bronchial tree (44.9% vs. 43.6%). Rigid bronchoscopic extraction of foreign bodies was the most common modality of extraction and was seen in 60 patients (76.9%), followed by thoracotomy and postural drainage in eight patients each (10.3%). Complications were observed in 12 patients (15.4%). Most of the patients who presented with pin aspiration were teenagers (> 10 - 20 years) and adults (> 20 years). At the same time, nut aspiration was common in children below 10 years. The location of FBs in the tracheobronchial tree depends on the patient's age and physical position at the time of aspiration. Rigid bronchoscopy offers better manipulations inside a secured airway and is the preferred method for foreign body removal. If failed, then surgical extraction should be done as soon as possible.

Neglected Foreign Bodies in Bronchi in Adults: Experience of 2 Cases

Tracheobronchial foreign body (FB) aspiration is a life-threatening condition that is more common in children than in adults. They are often diagnosed immediately and the foreign body is extracted as soon as possible. However, cases of neglected foreign body aspiration where it is unknown to the patients or they have forgotten the history of aspiration have been reported in the literature. The symptoms depend on the site of the FB impaction ranging from chronic mild wheezing, through to a cough, a complaint of discomfort, general shortness of breath, recurrent pneumonia, or mimicking asthma. In this article, we intend to illustrate two cases of forgotten bronchial foreign bodies that were successfully treated via the process of bronchoscopic extraction in Hanoi Medical University Hospital.

A RARE CASE OF BRONCHOLITHIASIS PRESENTING WITH CHRONIC COUGH AND MEDIASTINAL ABSCESS

TYPE: Case Report TOPIC: Disorders of the Mediastinum INTRODUCTION: Broncholithiasis is a rare condition characterized by the erosion of calcified material into the tracheobronchial tree. We present a case of broncholithiasis complicated by mediastinal abscess. CASE PRESENTATION: A 58-year-old male presented with chronic cough and lithoptysis. Chest PET-CT demonstrated calcified right infrahilar and subcarinal soft tissue with avid FDG uptake. Infectious workup was negative, including histoplasma and mycobacterium testing. Bronchoscopy demonstrated mucosal inflammation around the bronchus intermedius. Endobronchial biopsies and EBUS-TBNA were negative for malignancy. Symptoms persisted despite multiple courses of antibiotics and prednisone. Repeat CT showed evolving mediastinal fluid collection and gas. The patient underwent right lower lobectomy and mediastinal lymphadenectomy which showed broncholithiasis, necrotizing granulomas as well as fibrinous and organizing inflammation. Following surgery, he developed right hydropneumothorax requiring chest tube placement with polymicrobial growth consistent with empyema. He was treated with IV antibiotics with subsequent resolution of his symptoms. DISCUSSION: Broncholithiasis is an exceedingly rare cause of chronic cough. Tuberculous and histoplasma necrotizing granulomatous lymphadenitis are the most common causes. Lithoptysis is an uncommon, but a unique symptom of broncholithiasis. Mediastinal abscess is a rare complication as seen in this case. Diagnosis is established by CT imaging and bronchoscopy plays and important role. Depending on disease severity, management options range from observation to bronchoscopic extraction to surgical resection. Caution is advised when bronchoscopic treatment is considered due to the risk of massive bleeding upon manipulation of broncholiths. CONCLUSIONS: Broncholithiasis is a rare complication of mediastinal granulomatous processes that can present with chronic cough, hemoptysis as well as mediastinal abscess. DISCLOSURE: Nothing to declare.

Bronchoscopic Extraction of Multiple Endobronchial Broncholiths in A Patient with Active Pulmonary Tuberculosis

Broncholithiasis is an unusual clinical condition characterized by the presence of calcified or ossified material within the airways. Multiple endobronchial broncholithiasis during active infection with tuberculosis is an extremely uncommon presentation. Bron-choscopy plays an important role in the diagnosis and management of broncholithiasis. Currently, there are no specific guidelines for the management of broncholithiasis. Here, we present a case report where multiple broncholiths were successfully removed in a staged manner via rigid bronchoscopy.

Removal of foreign body (bottom of pen) in bronchus: An innovative technique

Abstract Foreign body (FB) aspiration in children is still a global medical problem. It is responsible for the accidental mortality in children. Non-food FB such as pen components is more frequent in the older children. In this case report, we present a challenging case with a bottom of a pen aspiration and describe a method for bronchoscopic extraction using similar aspirated foreign body.

Bronchial Penetration of Migrated Temporary Epicardial Pacing Wire with Bronchoscopic Extraction

Bronchial Penetration of Migrated Temporary Epicardial Pacing Wire with Bronchoscopic Extraction

Bronchotomy as a Safe and Feasible Alternative to Failed Bronchoscopic Removal of Foreign Body Inhalation in Pediatrics. A Seven-Year Review

Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with non- impacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study’s findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.

Massive Pulmonary Hemorrhage from Bronchial Varix

Bronchial varix is a rare pulmonary disorder which may lead to life-threatening hemorrhage. Diagnosis is difficult because of the subtle abnormalities on radiographic and bronchoscopic examination. We present a case of massive hemoptysis from a bleeding bronchial varix. In the absence of immediate complex endobronchial therapy in the island of Guam, this case was initially managed with nebulized and intravenous tranexamic acid. This was followed by endobronchial blockade of the bleeding airway with endobronchial epinephrine instillation. Selective bronchial artery embolization alleviated the acute-phase bleeding. Prone positioning was initiated due to severe hypoxia after blood clots compromised the patency of bilateral bronchial airways. Prone ventilation was employed for 17 hours for 2 consecutive days with intermittent bronchoscopic forceps extraction of airway blood clots while in the prone position. These maneuvers resulted to improved lung ventilation and oxygenation. The patient underwent bronchial sleeve resection surgery for definitive management.

Foreign body aspiration in children: what is variant in management?

Objective To evaluate children with foreign body aspiration (FBA) according to its incidence in pediatric, diagnostic tools, and the effectiveness of rigid bronchoscope. Background FBA is an important cause of morbidity and mortality in pediatrics. Management depends on the acuity of the presentation. Patients with evidence of complete upper airway obstruction should have age-appropriate basic life support maneuvers performed. Patients with partial obstruction who are able to maintain their airway but with potential for deterioration should be taken immediately to the operating room for removal whenever possible. Patients and methods In this prospective case series study, patients with suspected FBA up to 12 years old; presented to the Department of Otorhinolaryngology in Menoufia University Hospital in a period between April 2017 and September 2018 were enrolled to our work. Results Our study included 45 patients with different age groups prepared for bronchoscopic extraction. 43.9% of patients had right-sided foreign body (FB). Overall complications rate was 21.875%. These complications include hemoptysis, hoarseness of voice, laryngeal spasm, pulmonary edema, and temporary bronchospasm. Only one case failed to extract its FB. Conclusion It is concluded that the FB extraction in children occurred more for whom with low socioeconomic standard and higher number of siblings in one family. Rigid bronchoscope is used as diagnostic and therapeutic tool for patients with FBA to that could not be detected in radiological study.

Pneumopericardium after Foreign Body Aspiration: A Case Report

A case of spontaneous pneumopericardium occurred in the patient after the aspiration of no sharp foreign body. The patient was sent to Operation Theater (OT), bronchoscopic extraction of the foreign body was performed, and the patient was stable postoperatively. Serial follow up X-rayswere done and showed resolving of the pneumopericardium.

Erişkinlerde Trakeobronşial Yabancı Cisim Aspirasyonları: Üç Yılın Analizi

Aspiration of foreign bodies into the tracheobronchial tree is a common health problem in children and rare in adults, although incidence rates increase with advancing age. This study aimed to evaluate the safety and outcome of foreign body removal by rigid bronchoscopy A retrospective analysis of 3 years (2016-2019) of 20 patients who underwent rigid bronchoscopy for tracheobronchial foreign bodies A total of 20 patients underwent foreign body removal from the airway with rigid bronchoscopy . The median age of the patients was 50(range, 33-67) years , and 12 (60%) were male. Foreign bodies removed included 19(95%) with rigid bronchoscopy under general anesthesia.. The locations of the foreign bodies included the central airway (n = 6; trachea, right bronchial tree (n = 9), and left bronchial tree (n = 5). Successful removal was observed in 19 (95%) cases. One patient underwent thoracotomy because of the failure of the removal with rigid broncoscopy. Rigid bronchoscopic extraction of a foreign body in the airway under general anesthesia can be performed successfully with minimal complications.

Broncholithiasis Masquerading as Asthma

Broncholithiasis is the presence of osteoid material molded in the bronchial lumen.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar It produces chronic inflammation leading to airway obstruction mimicking asthma. A 52-year-old lifelong nonsmoker woman complained of constant, progressive, dry cough for 3 months. The patient denied precipitating factors, previous events, and aggravating or alleviating factors. Her cough was associated with halitosis, subjective weight loss, chest tightness, wheezing, urinary stress incontinence, and dyspnea. Past medical history was significant for exercise-induced bronchospasm, she denied the use of prescribed or over-the-counter medication, and the physical examination revealed expiratory wheezing. On the basis of findings, we diagnosed asthma. The result of the methacholine challenge was positive; nonetheless, the patient did not improve after a trial of 2 dry-powder inhalers with high-dose inhaled corticosteroids/long-acting beta-agonist (fluticasone propionate/salmeterol and fluticasone furoate/vilanterol), and systemic steroids. Two episodes of pneumonia complicated her course, and a chest computed tomography performed after the second episode revealed a broncholith in the right bronchus (Figure 1). Finally, the foreign material was extracted with a bronchoscope (Figure 2), leading to complete symptomatic relief.Figure 2Broncholith material after bronchoscopic removal.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Most cases of broncholithiasis are secondary to chronic lymphadenitis caused by histoplasmosis, foreign body aspiration, ossified bronchial cartilage, and osteoid material migration from other parts of the body.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Patients often present with chronic cough, dysphagia, lithoptysis, hemoptysis, and recurrent pneumonias.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Often, findings in x-rays are nonspecific (hilar calcification or parenchymal infiltrates, depending on the etiology), so a computed tomography is required to diagnose, localize, and detect the degree of airway obstruction.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Clinical management is preferred over surgery because of the risk of bleeding; however, severe cases require bronchoscopic or surgical extraction.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar In conclusion, broncholithiasis can produce airway obstruction and chronic inflammation resembling asthma.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Physicians must consider alternative diagnoses in patients with atypical asthma, unresponsive to medical treatment in spite of a positive methacholine challenge test result.2Coates A.L. Wanger J. Cockcroft D.W. Culver B.H. Carlsen K. Diamant Z. et al.ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests.Eur Respir J. 2017; 49: 1601526Crossref PubMed Scopus (176) Google Scholar

Foreign body aspiration – still a challenge in pediatrics?

Tracheobronchial foreign body aspiration in children represents a diagnostic and therapeutic emergency in the practice of pediatricians and ENT specialists. Delaying the diagnostic and, implicitly, the bronchoscopic extraction of the foreign body can lead to complications, some even with vital prognosis. In this paper, the authors present from their personal experience two pediatric cases of tracheobronchial foreign bodies diagnosed and treated at different time intervals after the moment of aspiration.

Management of broncholithiasis.

Broncholithiasis is a condition in which calcified material has entered the tracheobronchial tree, at times causing airway obstruction and inflammation. Broncholiths generally originate as calcified material in mediastinal lymph nodes that subsequently erode into adjacent airways, often as a result of prior granulomatous infection. Disease manifestations range from asymptomatic stones in the airway to life-threatening complications, including massive hemoptysis and post-obstructive pneumonia. Radiographic imaging, particularly computed tomography scanning of the chest, is integral in the evaluation of suspected broncholithiasis and can be helpful to assess involvement of adjacent structures, including vasculature, prior to any planned intervention. Management strategies largely depend on the severity of disease. Observation is warranted in asymptomatic cases, while therapeutic bronchoscopy and surgical interventions may be necessary for cases involving complications. Bronchoscopic extraction is often feasible in cases in which the broncholith is freely mobile within the airway, whereas partially-embedded broncholiths represent additional challenges. Surgical intervention is indicated for advanced cases deemed not amenable to endoscopic management. Complex cases involving complications such as massive hemoptysis and/or bronchomediastinal fistula formation are best managed with a multidisciplinary approach, utilizing expertise from fields such as pulmonology, radiology, and thoracic surgery.

Foreign body removal by flexible bronchoscopy using retrieval basket in children.

OBJECTIVES:Aspiration of foreign bodies into the tracheobronchial tree is a common accident in children. This study aimed to evaluate the safety and outcome of foreign body removal by flexible bronchoscopy using a retrieval basket in children.METHODS:This was a retrospective study of children treated for foreign bodies in the airway via flexible bronchoscopy using a retrieval basket at a tertiary hospital in Korea between February 2014 and October 2017. The medical records of the patients were retrospectively reviewed and analyzed.RESULTS:A total of 20 children underwent foreign body removal from the airway via flexible bronchoscopy using a retrieval basket. The median age of the patients was 16 (range, 10–21.5) months, and 12 (60%) were male. Foreign bodies removed included 16 (80%) organic items including peanuts, almond, and beans, and 4 (20%) inorganic items including a plastic bag, metal screw, spring, and Lego brick. The locations of the foreign bodies included the central airway (n = 5; trachea, n = 4; subglottic area, n = 1), right bronchial tree (n = 9), and left bronchial tree (n = 6). Successful removal was observed in 18 (90%) cases. The only complication that occurred was mild laryngeal edema (n = 2) after the procedure; both improved with corticosteroid administration.CONCLUSION:Flexible bronchoscopic extraction of a foreign body in the airway using a retrieval basket in children can be performed successfully with minimal complications.

Pen Cap Aspirations: Maneuvering for Successful Extraction

Aim of this study was to analyze the therapeutic approach with enhanced success of bronchoscopy. We retrospectively analyzed the results of bronchoscopic extraction of pen cap aspirations in our unit from 2000 to 2014. Out of 239 bronchoscopies performed for foreign bodies in airways, there were 8 cases of pen cap aspirations. All 8 were males and age ranged from 5 to 11 years. Seven cases had definitive history, while one patient had a history of chronic respiratory ailment. The foreign bodies were lodged in right and left bronchi in four cases each and seven had their open-end toward the proximal airways. Bronchoscopic extraction was successful in seven patients. The maneuver of rotating the optical forceps by 90 degrees so as to align the pen cap with the vocal cords resulted in success in all the cases. One patient underwent thoracotomy and bronchotomy for removal. Pen cap aspirations occur in school-going children. Aligning the optical forceps with vocal cords during extraction avoids the need for tracheostomy or thoracotomy.

Incidence, patterns and different modalities in extraction of aero-digestive tract foreign bodies in patients attending Alexandria Main University Hospital

BackgroundAero-digestive tract foreign bodies (FB) are commonly seen either in children or in elderly age group. Various methods have been described in literature for their removal. In our study we aimed to analyze the incidence, risk factors, site, clinical presentations, different modalities used to extract tracheobronchial and esophageal foreign bodies in patients presented with FB aspiration or ingestion to the Emergency, Cardiothoracic Surgery, ENT and Chest disease departments in Alexandria Main University Hospital during the period between 1-11-2014 to 1-11-2015. MethodsA review of ninety patients with alleged FB aspiration and one hundred patients with alleged FB ingestion underwent complete history taking including personal data, date of presentation, date of aspiration or ingestion, circumstances of aspiration or ingestion, and past history of any previous medical or surgical conditions. Clinical assessment included vital signs and complete physical examination & investigations e.g.; complete blood count, random blood sugar, coagulation profile, renal function tests and liver function tests. Imaging including plain X-ray, CT scan, ultrasound, and virtual bronchoscopy were done. Some patients underwent rigid esophagoscopy/bronchoscopy under general anesthesia, based on clinical and radiological evidence. Some patients underwent surgical interventions. ResultsRegarding FB aspiration, we found that sex difference was statistically significant in teenagers and adult group; females were found to be more commonly affected than males. Also most of cases of pin aspiration were teenagers (>10–20 years) and adults (>20 years). We noticed that right main bronchus FB was found more frequently in children below 10 years. Rigid bronchoscopic extraction of the FBs was the most common modality of extraction seen in 70 patients (77.8%). Regarding FB ingestion we noticed that females were commonly affected than males, coins were the most commonly ingested FB; and upper oesophageal sphincter (UES) was the commonest site of FB entrapment. ConclusionsFBs in the aero-digestive tract constituted a constant hazard in all age groups especially in children and the elderly, which demanded immediate action and management.

小児気道異物に対するバスケット鉗子を用いた軟性気管支鏡下摘出術の有用性

小児気道異物に対するバスケット鉗子を用いた軟性気管支鏡下摘出術の有用性