Cases Of Foreign Body Aspiration Research Articles

Clinicodemographic Profile and Treatment Outcomes of Patients with Upper Aerodigestive Tract Foreign Bodies in the Southern Philippines Medical Center: A Five-Year Retrospective Review

Objective: This study aims to describe the clinicodemographic profile of patients with foreign bodies in the upper aerodigestive tract and their treatment outcomes. Methods: Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Records of 304 patients diagnosed with aerodigestive foreign bodies Results: Three hundred-four (304) patients were included. The median age was 5.26 years in the pediatric age group and 42.53 years in the adult age group, with a male-to female ratio = 1.97:1. Foreign bodies were ingested in 291 (96%) patients while aspiration occurred in 13 (4%). Overall, 211 (69%) of cases involved the pediatric population (<19 years) and 93 (31%) the adult population. The most common foreign bodies reported were coins (63.5%), food (18.1%), and dentures (11.5%). Most esophageal foreign bodies (244/291; 83%) were seen at the cricopharyngeal level in all age groups. The foreign body was removed successfully in 288/291 (98%) of ingestion cases. All 13 cases of foreign body aspiration were successfully removed by bronchoscopy. All patients were discharged improved. Conclusion: Most upper aerodigestive tract foreign bodies involved the pediatric age group. Predisposing conditions were mainly due to accidental ingestion and aspiration while playing in the pediatric population and negligence in eating among adults. Almost all ingestion cases were successfully treated with esophagoscopy, while all aspirations were treated successfully with bronchoscopy. Most intraoperative and postoperative complications who were managed conservatively by observation, although some cases required referral to other surgical departments and were treated surgically. All patients were discharged improved

Foreign body aspiration in children at University of Gondar Comprehensive Specialized Hospital, a two year retrospective study

IntroductionForeign body aspiration (FBA) is defined as asphyxia, suffocation, or inhalation of items of food, such as bone and seed, and non-food, such as toys, into the respiratory tract. Aspiration of foreign bodies is an important and preventable cause of mortality and morbidity in children, especially those less than 3 years of age. The aim of this study was to analyse the clinical and radiological profile, modes of management, and outcomes of foreign body aspiration in children at the University of Gondar Comprehensive Specialized Hospital and identify areas of possible interventions for proper management of such cases. MethodA retrospective review of the medical records of all patients suspected of foreign body aspiration at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from January 1, 2021, to January 1, 2023, G.C. was conducted. Clinico-radiological features, types and locations of foreign bodies, modes of management, and patient outcomes were studied. ResultsA total of 73 patients suspected of having a possible foreign body aspiration were identified. The median age of the patients was 24 months, with an IQR of 14 and 39, with 46 (75.3 %) being under 3 years of age. 45 (61.6 %) were male, while 28 (38.4 %) were female, making the M:F ratio 1.6:1. A foreign body aspiration history could be obtained in 68 (93.1 %) of the patients, while in 4 (5.9 %) of the cases, patients or their families were not aware of any kind of aspiration. Among the children presented, 65 (89 %) had a choking episode, coughing 66 (91 %), vomiting 63 (86.3 %), tachypnea 61 (83.6 %), and stridor 15 (20.5 %). The most common physical finding observed was nasal flaring along with subcostal and intercostal retraction in 59 (80.8 %), followed by decreased air entry in 40 (54.8 %), wheeze in 37 (50.7 %), and absent air entry in the affected side in 4 (5.5 %) of the patients. A chest x-ray was done on all patients. 28 (41.2 %) had normal chest x-rays. With regard to procedure-related complications, 3 (4.1 %) patients had cardiac arrest, 1 (1.36 %) had pneumothorax, and 1 patient died. ConclusionAny bronchopulmonary infection with an unusual course should be suspected of being the result of the aspiration of a foreign body. Increased public and professional awareness of the importance of early bronchoscopy in all suspected cases of foreign body aspiration is necessary. In order to lower the incidence, those providing care must be taught routine preventive measures.

A Case of Foreign Body Aspiration Mimicking Asthma in Adult

Foreign body aspiration is uncommon in adults who have no known risk factors such as mental retardation, poor dentition, or advanced age. Adults with foreign body aspiration are commonly misdiagnosed with bronchial asthma, however, does not respond to standard bronchodilator treatment. A thorough history-taking, focused physical examination and a high index of suspicion is crucial in making the correct diagnosis. This paper reports an interesting case of a 41- year-old woman with an undetected 10-year long foreign body aspiration which was misdiagnosed as bronchial asthma.

Foreign bodies of the lower respiratory tract in children

Foreign bodies of the lower respiratory tract in children is one of the major life-threatening emergencies in children, having a high rate in the structure of infant mortality. This patology represents about 11% of otorhinolaryngological emergencies [2]. In the USA the statistics recorded eloquent data over a year. The intra-hospital mortality rate associated with these cases accounts for 1,8%, and anoxic brain injury is reported in 2,2% of cases. Thus, foreign body aspiration was diagnosed mainly in children aged 1-3 years, with the frequency of 56%, and the death rate of 7% [5]. Foreign bodies enter to the body by natural ways and have a diverse location, depending on their size, shape and nature. The most common location of foreign bodies is in the bronchi of the right lung, followed by the left bronchial tree and most rarely, in the trachea. Very rarely, are encountered foreign bodies with multiple locations [6]. In the etiological structure, foreign bodies of organic origin predominate - 15%, especially foreign bodies of plant origin - 75-81%, less frequently metallic foreign bodies - 10% and plastic - 5% [2,5]. Statistical age analysis of foreign body aspiration cases reported that, 21% cases are determined in children after the age of 6 months, more than half cases - in child 1-3 years and 1⁄4 cases - in children older than 3 years [1,3].

PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies.

To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: •Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: •This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.

Can Clinical and Radiological Diagnosis Reduce the Need for Bronchoscopy in Pediatric Tracheobronchial Foreign Body Aspiration Cases?

ObjectivesTo assess the diagnostic accuracy and efficacy of taking history, conducting physical examination, and assessing the radiological characteristics of children suspected of having aspirated foreign bodies (FBs), vis-à-vis tracheobronchoscopy, the gold standard diagnostic tool. An additional objective was to analyze the types and locations of aspirated FBs.MethodsThis single-center retrospective cohort study used the archived medical data of consecutive pediatric patients who had presented with suspected tracheobronchial FB aspiration (TFBA) from January 2011 to May 2021. Data regarding clinical presentation, radiological impressions, and intraoperative findings were retrieved from electronic medical records.ResultsThe subjects comprised 44 children (22 male) with a mean age of 25.4 months (median = 17.5 months). The majority (27; 61.4%) had TFBA. Among the clinical symptoms, choking and coughing had a sensitivity of 93.9% and specificity of 30.0% and 50.0%, respectively in confirming the presence of a FB. Positive physical examination results had a sensitivity of 95.8% and specificity of 63.2%. Radiological results had a sensitivity of 60.0% and specificity of 78.9%. Organic substances constituted 47.7% of the aspirated FBs.ConclusionsProper clinical assessment with history, physical examination, and imaging can highly predict the presence of TFBAs in children, and help the clinician decide whether bronchoscopy is necessary.

Foreign-body aspiration into the lower airways in adults; multicenter study.

BackgroundForeign-body aspiration is common in children aged 6 months to 3 years. However, with the aging population and increasing prevalence of disabilities such as hemiparesis and neuromuscular diseases in adults, an increased incidence of aspiration is expected.MethodsThis was a multicenter retrospective, observational study in four major referral hospitals in Daegu, South Korea, between 2000 and 2019. We included patients aged over 18 years who were evaluated for tracheobronchial foreign-body aspiration by flexible bronchoscopy. Comorbidities, type and location of foreign body, and radiologic findings were recorded.ResultsOf 138 patients who underwent flexible bronchoscopy for tracheobronchial foreign body aspiration, 91 (65.9%) were men; the mean age was 66.3 (range: 29–87) years. A history of definite choking was present in 60 (43.5%) patients. The most common site of the foreign body was the right bronchus intermedius (27.5%). The most common type of aspirated foreign body was teeth (37.7%), followed by chicken bone (15.2%), nuts (14.5%) and fish bone (9.4%). Iatrogenic events accounted for 37.0% of the cases of aspiration, and the foreign body was successfully removed by flexible bronchoscopy in 91.3% of cases.ConclusionForeign-body aspiration is not rare, even in adults who do not have predisposing factors. Iatrogenic events accounted for about 40% of all cases of foreign body aspiration. In adults, flexible bronchoscopy is relatively safe and has a high success rate for foreign-body removal.

A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients.

Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. We searched the PubMed database from 1January 2001 to 9 October 2021 for peer-review papers published in English on the use, and success rates, of flexible bronchoscopy as the first-line treatment for foreign body aspiration cases. This process identified 243 potential papers. We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23studies and laryngeal mask airways were mostly used in 10/23studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies.

Spontaneous Non-Traumatic Emphysema in Toddler: The Neglected Foreign Body

Foreign body aspiration is a major cause of fatality and morbidity in children. The child may present acutely with signs of respiratory distress or chronically with symptoms suggestive of respiratory infection. Variable presentations make it difficult to diagnose a case of foreign body aspiration, especially in the absence of a clear history of aspiration. Subcutaneous emphysema and pneumomediastinum are rare presentations. Here, we report a case of 2-year-old child who presented with non-traumatic extensive neck and upper chest subcutaneous emphysema. Computed tomography revealed there was presence of foreign body in left bronchus. Emergency bronchoscopy found a piece of peanut in the left main bronchus. It was successfully removed and the patient was discharged well after three days.

Peanut Aspiration A Pandemic Peril in Pediatric Population During COVID 19 Lockdown; Rigid Bronchoscopy A Ramrod for Grapple

Recent studies have shown that there is a strong correlation between covid-19 pandemic lockdown and surge in number of cases of Foreign body aspiration [FBA] especially Peanut in paediatric age group. It has been witnessed that foreign body aspiration is seen among children of low socioeconomic strata and migrant population because peanut is most common affordable snacks available during containment. Also it is seen among children of working parents and migrant labours,therefore it goes unwitnessed making diagnosis and treatment late. This review article out sketches the early and late manifestations, clinical evaluation and management of peanut aspirationin paediatric population during pandemic lockdown by timely role of paediatrician and itsretrieval by rigid bronchoscopy performed by otorhinolaryngologist.The best method for diagnosing and conveniently treating FBA is rigid bronchoscopy. In review of many cases of clinically diagnosed FBA, bronchoscopy resulted in a 99% success rate in removing identified foreign objects.

Evaluate the Role of Rigid Bronchoscopy in Tracheo-Bronchial Foreign Bodies.

Tracheobronchial foreign bodies continue to present challenges to practitioners worldwide. The major issues involve the accurate diagnosis and speedy and safe removal of the foreign bodies. The aim of this study was to to assess an epidemiological data regarding airway foreign bodies in patients presenting to our institute and to assess the role of rigid bronchoscopy for diagnosis and management of cases of foreign body aspiration. Study was conducted between December 2015 and July 2021 in Otorhinolaryngology and Head and Neck Surgery Department. 200 patients who underwent rigid bronchoscopy in above period for suspected foreign body aspiration was included in the study. All the parameters was recorded and analysed in an attempt to define the epidemiology, clinical presentation, management and associated morbidity. Descriptive statistical analysis was done using SPSS software version 22 of Windows 7. Tracheo-bronchial foreign bodies (TFB) were more common in pediatric age group. 80% of our patients with TFB were aged less than 3years. Most common symptom was cough (70%) and the commonest sign was diminished unilateral breath sounds (72%). Peanut was the commonest (45%) foreign body. Most common site of lodgement of TFB was right main bronchus (49%). TFB aspiration is always accidental and sudden with high mortality. It is a life threatening condition and needs urgent intervention. Rigid bronchoscopy under general anesthesia represents a safe and effective tool in the management of TFB aspiration.

Fish Bone in the Glottis of a Seventeen-Month-Old Child: A Case Report

Foreign body aspiration is one of the leading causes of accidental death in children. Young children tend to put objects in their mouths which may additionally explain the incidence of foreign body aspiration. Laryngeal impaction of a foreign body is very rare as most aspirated foreign bodies pass through the laryngeal inlet and get lodged lower down in the airway. Inhaled foreign bodies are suspected from the history of incidence witnessed by the parent or caregiver or at times from clinical symptoms of respiratory complains not responding to medical therapy. Removal of the foreign body from the airway is the modality of treatment done via rigid bronchoscopy under general anesthesia in our setting. A rare case of foreign body aspiration with glottic impaction in very young child of seventeen months has been described here.

A Case of Whistle as Foreign Body in Trachea

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.

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

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

THE MONEY IS IN THE AIRWAY: AN ATYPICAL CASE OF NON-CARDIAC CHEST PAIN

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Fellow Case Reports INTRODUCTION: Foreign body aspiration is a common pathology in pediatric medicine but relatively infrequent in the adult population. Symptoms are usually those of acute airway irritation, including cough, dyspnea, and asphyxiation. Acute chest pain is an uncommon manifestation of foreign body aspiration and one that may be overlooked if history suggests another leading diagnosis. It is critical to avoid such a confounding bias, as anchoring can lead to adverse patient outcomes. CASE PRESENTATION: A 58-year-old man with diabetes mellitus, hypertension, coronary artery disease, and a history of substance abuse presented to the emergency department (ED) complaining of chest pain. He described a mid-chest pain that started after consuming cocaine. The pain was non-radiating but associated with mild shortness of breath. In the ED, he was tachycardic, hypertensive, and with normal saturation at room air. His EKG showed sinus tachycardia, and the laboratory workup was unremarkable. Chest X-Ray (fig.1) showed a round metallic density over the left mid lung. Chest CT scan (fig.2 and 3) showed a hyperattenuating foreign body within the left mainstem bronchus. He underwent a bronchoscopy in the operating room, and a dime was retrieved from the left mainstem bronchus with forceps. He tolerated the procedure well with no complications or airway injury and discharged home in stable condition. DISCUSSION: Despite the unusual times we have been going through due to the COVID-19 pandemic, ischemic heart disease remained the leading cause of death in the United States during 2020(1). It is well established that the abuse of illicit substances such as cocaine could lead to myocardial ischemia and infarction (2). Thus, it is a top differential diagnosis when a patient arrives in the ED with chest pain after cocaine use.It is well documented how premature closure and anchoring bias could negatively impact clinical outcomes (3,4,5). Hence, a thorough history and differential diagnosis are paramount to guide the workup and management. Cases of foreign body aspiration in adults often happen in the setting of altered mental status (6) or acute intoxication where patients rarely recall further details leading to their onset of symptoms. Still, the typical presentation includes cough and dyspnea (7) rather than chest pain.In a case of patient-reported recent cocaine use with subsequent chest pain, anchoring to a cocaine-induced chest pain diagnosis is at first understandable. It was the chest pain diagnostic workup that included a chest x-ray that found the cause that was not initially suspected. CONCLUSIONS: We present an interesting case of a dime aspiration lodging the left mainstem bronchus, who presented with chest pain after consuming cocaine. The lack of classic respiratory symptoms and the recent intoxication could have led to anchoring bias where the foreign body aspiration might have been overlooked. REFERENCE #1: 1. Ahmad FB, Cisewski JA, Minino A et al. Provisional Mortality Data – United States, 2020. MMWR Morb Mortal Wkly Rep 2021;70:519-522. REFERENCE #2: 2. McCord J, Jneid H, Hollander JE et al. Management of Cocaine-associated chest pain and myocardial infarction. Circulation. 2008;117:1897–1907. REFERENCE #3: 3. Khadilkar, S.V., Khadilkar, S.S. Bias in Clinical Practice. J Obstet Gynecol India 2020. 70, 1–5. https://doi.org/10.1007/s13224-019-01304-5 4. Makary MA, Daniel M. Medical error – the third leading cause of death in the US BMJ 2016;353:I2139 doi:10.1136/bmj.i2139 5. Saposnik, G., Redelmeier, D., Ruff, C. et al. Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 2016(1), 138. https://doi.org/10.1186/s12911-016-0377-16. Ozdemir et al. Foreign Body Aspiration in Adult. Eurasian J Pulmonol 2015;17: 29-34 7. Bajaj et al. Foreign Body aspiration. J Thorac Dis 2020. doi: 10.21037/jtd.2020.03.94 DISCLOSURES: No relevant relationships by Israel Acosta Sanchez, source=Web Respons No relevant relationships by Tirsa Ferrer Marrero, source=Web Response No relevant relationships by Ray Urban, source=Web Response

An unusual case of foreign body aspiration

Our aim is to present the importance of mobile Handheld Lung Ultrasound (HLUS) in COVID-19 patients at the bedside, which is a pre-screening tool with high diagnostic value that can provide triage of symptomatic patients at home (pre-hospital), emergency services, Intensive Care Units (ICU). In this context, the current role and importance of HLUS at the bedside in COVID-19 pneumonia has been summarized.

An Unusual Case of Foreign Body Aspiration in 6-year-old Boy

Foreign body aspiration (FBA) is a common cause of mortality and morbidity in children. FBA is not always immediately diagnosed, partly because this diagnosis is not frequently in mind, but also because FBA does not have a specific clinical manifestation. FBA can be misdiagnosed as asthma, upper respiratory tract infection, pneumonia, or croup. Sometimes, FBA can be completely asymptomatic. We present the case with a delay in diagnosing FBA and discuss the appropriate management of suspected foreign body aspiration in a 6-year-old boy. This case illustrates the need for prompt action and a high level of suspicion in patients with prolonged symptoms and no resolution with standard treatment. Diagnosis should always be based on a combination of data obtained from the clinical history, physical examination, and radiographic findings. However, the normal appearance of a chest X-ray does not exclude the possibility of FBA.

Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature.

(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.

Management of tracheo-bronchial foreign bodies at a tertiary care hospital in Eastern part of India

Accidental Foreign body aspiration is common in children presenting to emergency outpatient department. Early diagnosis from clinical and radiological investigations is pivotal for successful removal of aspirated foreign body. We here report 35 cases of foreign body aspiration with respect to clinical features, type and location of foreign body, complications during bronchoscopy.To evaluate the clinical presentation, diagnosis & management of tracheo-bronchial foreign bodies in a tertiary care hospitalThis was a retrospective study of 35 cases of foreign body removal done between January2018to January2020. We included those cases that had history of aspiration, sudden onset of breathlessness or choking sensation in a healthy person, recurrent respiratory infections with clinical or radiological evidence, and suspicion of foreign body. Every case was documented with respect to age, sex, nature, site of foreign body lodgement, duration between inhalation or symptoms and admission in a hospital, clinical symptoms and signs, chest radiography findings, results and complications of bronchoscopy.The most common age group was between 1-6 years. Most of the patients attended hospital after 7 days of aspiration without any emergencies. History of aspiration and respiratory distress were the common presentation. Fever was present in those who presented late to the emergency department. About 25 cases (71.4%) had diminished or absent breath sounds followed by 12 cases (50%) of stridor, 15 cases (42.8%) diminished percussion notes. The common radiographic finding is obstructive emphysema and commonest site was right bronchus. Most of the foreign bodies were vegetative in nature.Early investigation with bronchoscopy is warranted when a strong clinical suspicion exists for foreign body aspiration, since bronchoscopy helps to resolve the symptoms quickly and prevent further complications

Age based evaluation of nut aspiration risk

ObjectiveTo identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway.MethodA retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events.ResultsSixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher’s exact test was carried out on the cumulative percentage of organic foreign body aspirations to identify the age distribution of nut aspiration events. A statistically significant decrease in organic foreign body aspirations occurred at approximately 36 months of age (p = 0.004).ConclusionForeign body aspiration is a leading cause of accidental injury or death in children. Nut and other small organic foreign bodies account for a significant portion of accidental aspiration events, however, no guidelines exist regarding appropriate age of whole nut introduction into the diet. Our study suggests that 90% of pediatric nut aspiration events occur under the age of 36 months. We suggest supervised introduction of whole nuts between the ages of 3 and 4 years. Official guidelines regarding this should be considered by professional pediatric societies.Level of evidence4