Foreign Body Aspiration In Adults Research Articles

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

SUCH A TWEEZE: BRONCHOSCOPE-MEDIATED EXTRACTION OF ASPIRATED FOREIGN BODY

SUCH A TWEEZE: BRONCHOSCOPE-MEDIATED EXTRACTION OF ASPIRATED FOREIGN BODY

Medical Image of the Month: An Unexpected Cause of Chronic Cough

No abstract available. Article truncated after 150 words. Sometimes it is as simple as it looks! A previously healthy nonsmoking 40-year-old man presented with a 7-month history of dry cough which was misdiagnosed as asthma. He had persistent cough despite appropriate asthma treatment including empiric PPIs. This patient had undergone extensive lab work up and evaluation; from negative viral and fungal panel, repeated pulmonary function tests which were within normal limits, chest x-rays, and CT scans which had shown small local calcification in the bronchus intermedius with significant thickening of the surrounding bronchial wall (Figure 1). The decision was made to proceed with flexible bronchoscopy, which yielded a chicken bone fragment with surrounding granulation tissue as shown in Figure 2A. In retrospect the bone is visible within the bronchus intermedius on the topogram from the CT scan, see Figure 2B. Foreign body aspiration in adults reported in low rates (0.66 per 100 000) (1). Despite being uncommon, neurological …

Lung Abscess in Adult with Foreign Body (Tooth)

Lung abscess due to foreign body aspiration in adults is relatively rare and is more common in childhood. The number of patients with lung abscess has decreased because of antibiotic therapy; therefore, chest X-rays in cases of abscesses have decreased.1 Chest computed tomography (CT) allows for an improved study of lesions and other associated findings, and when cavitation is present, it allows evaluation of the walls, the content with necrotic fluid, and gas.2 In the presence of a foreign body, in addition to axial scans, multiplanar reconstructions and the virtual bronchoscopy technique have made it possible to identify the trachea and bronchial tree and often delimit the foreign body according to its density, shape, or whether it is surrounded by secretions.

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

ALL THAT PET POSITIVE IS NOT CANCER

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: PET (Positron emission tomography)/CT (Computed tomography) is a common modality used to diagnose and stage various malignancies. Radiotracer FDG (Fluoro18-deoxyglucose) is not cancer-specific and false-positive results may be observed in a wide variety of non-malignant conditions. Here we describe a patient with FDG avid left lower lobe endobronchial mass. CASE PRESENTATION: 75 years old female with a medical history significant for type 2 diabetes mellitus, seizure disorder was referred to pulmonology clinic with shortness of breath, intermittent wheezing, and non-productive cough for 2 months. She denied chest pain, orthopnea, fever, chills, weight or appetite changes, night sweats. The patient is a former smoker with less than 20 pack-year, quit two decades ago. On physical exam, the patient was saturating 92% in room air. BMI was 44.99 kg/m2. Lung examination showed reduced breath sounds at the left lung base. The rest of the exam was unremarkable. The pulmonary function test was normal. Outpatient evaluations were unremarkable. Chest X-ray showed left lower lobe infiltrates. CT chest showed left lower lobe consolidation vs atelectasis of left lung base followed with PET/CT which revealed increased FDG uptake in left lower lobe intraluminal density with SUV 6.5 concerning for malignancy with endobronchial involvement vs inflammatory process. Diagnostic bronchoscopy showed left lower lobe bronchus with significant mucosal hyperemia and edema with yellowish-white foreign body (FB) which was successfully retrieved with endobronchial biopsy forceps and noted to a piece of corn. The patient's symptoms resolved. DISCUSSION: The reported false positive rate of PET/CT was 13% and attributed to FDG uptake by inflammatory cells at the sites of inflammation or infection. Most common FDG avid non-infectious inflammatory etiologies include sarcoidosis, atherosclerosis, pneumoconiosis, and focal foreign body-related inflammation. FB aspiration in the tracheobronchial tree is rare in adults and usually presents with subtle respiratory symptoms with paucity in imaging. Risk factors include loss of consciousness from trauma, drug, seizure disorder or alcohol intoxication, dysphagia related to age-related slowing, stroke, dementia, or Parkinson's disease. In our case, false positives artifacts were related to a focal foreign body (FB) related inflammation with an elevated risk of aspiration related to a seizure disorder, and advanced age. Removal of FB from the tracheobronchial tree may be achieved with flexible bronchoscopy with biopsy forceps or retrieval basket. Rigid bronchoscopy may be needed if flexible bronchoscopy was unsuccessful. CONCLUSIONS: It is essential to understand false positive results while interpreting PET/CT results. FB aspiration in adults is rare and high clinical suspicion is necessary for the diagnosis. Removal of FB can usually be accomplished with bronchoscopy. REFERENCE #1: Common causes of False-positive F18 FDG PET/CT scans in oncology- Kevin R Carter, Eduard Kotlyarov; Vol,50, special number: pp.29-35, September 2007 Brazilian Archives of Biology and Technology- an International Journal. REFERENCE #2: Non-asphyxiating tracheobronchial foreign bodies in adults- Lan RS, Eur Respir J. 1994;7(3): 510 REFERENCE #3: Tracheobronchial foreign bodies in adults- Limper AH, Prakash UB, Ann Intern Med. 1990; 112(8):604 DISCLOSURES: No relevant relationships by Mansur Assaad, source=Web Response No relevant relationships by Rajamurugan Meenakshisundaram, source=Web Response No relevant relationships by FARAZ Siddiqui, source=Web Response

ENDOBRONCHIAL FOREIGN BODY ASPIRATION MIMICKING AN ENDOBRONCHIAL TUMOR

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Aspiration of foreign body (FB) into the airways may have an indolent presentation in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by radiography and bronchoscopy, some patients are misdiagnosed as having endobronchial tumors. We describe an interesting case of bronchus intermedius FB that mimicked an endobronchial tumor. CASE PRESENTATION: A 61-year-old, male long-time heavy smoker with history of excessive alcohol use and stroke with residual left-sided hemiparesis presented with a 3-month history of worsening dry cough, hemoptysis and dyspnea. Chest computed tomography revealed occlusion of the bronchus intermedius with an enhancing lesion highly suspicious for an obstructing bronchial mass, along with moderate pleural effusion and enlarged subcarinal lymphadenopathy. Thoracentesis of the pleural effusion showed exudative fluid with predominantly neutrophilic cells that was negative for malignancy on cytology twice. Flexible bronchoscopy a firm, endobronchial lesion causing near total occlusion of the bronchus intermedius. Forceps endobronchial biopsy of the lesion and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of a subcarinal lymph node revealed no malignant cells. The patient then underwent flexible bronchoscopy with removal of the occluding lesion using cryoablation. The obstructing mass appeared to be freely movable when the cryoprobe was attached to it. A basket was used to retrieve the entire resected mass, which appeared to be an aspirated pill surrounded by granulation tissue on gross examination. Histopathology of the specimen showed no evidence of malignancy but was consistent with FB aspiration. DISCUSSION: Symptoms of FB aspiration in adults may be absent and often delayed, in some reports for up to 26 months. Dysphagia and impaired cough reflex are the main mechanisms for FB aspiration. This was likely the case in our patient with a history of stroke and excessive alcohol use. In case of such an indolent presentation and invisibility of the FB on chest imaging due to formation of granulation tissue, FB aspiration may be overlooked in adults. In our patient, this was further cofounded by the presence of pleural effusion and mediastinal lymphadenopathy, which were concerning lymphadenopathy, but were likely due to post-obstructive pneumonia. Bronchoscopic cryotherapy, which resulted in the correct diagnosis in this patient, has been described in the diagnosis of benign and malignant lesions of the airways and for recanalization. CONCLUSIONS: This case highlights the importance of suspecting FB aspiration when evaluating airway lesions. Choice of a noninvasive method, such as bronchoscopic cryotherapy, for removing an endobronchial lesion, may preclude the need for thoracotomy. REFERENCE #1: 1- Alharthi BJ, et al. Occult foreign body in the lung mimicking bronchogenic carcinoma. BMJ Case Rep. 2014;2014:bcr2014207438. Published 2014 Dec 17. doi:10.1136/bcr-2014-207438 REFERENCE #2: 2- Hewlett JC, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-3409. doi: 10.21037/jtd.2017.06.137. PMID: 29221325; PMCID: PMC5708401. REFERENCE #3: 3- Sehgal IS, et al. Use of cryoprobe for removal of a large tracheobronchial foreign body during flexible bronchoscopy. Lung India. 2016 Sep-Oct;33(5):543-5. doi: 10.4103/0970-2113.188978. PMID: 27625452; PMCID: PMC5006338. DISCLOSURES: No relevant relationships by Omar Abdulfattah, source=Web Response No relevant relationships by Muath Alsharif, source=Web Response No relevant relationships by Traves Crabtree, source=Web Response no disclosure on file for Keivan Shalileh

AN OBSTACLE AROUND THE CORNER

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Post obstructive pneumonia (POP) is found in 2-5% of patients with community acquired pneumonia (CAP), characterized by infection distal to a mechanical obstruction of the bronchus. Post obstructive pneumonia is in the differential diagnosis in patients with recurrent infections in the same lung segment(s). Bronchoscopic intervention is usually diagnostic and may also be therapeutic in certain cases. We present a case of post obstructive pneumonia which was later found to be secondary to foreign body aspiration. CASE PRESENTATION: A 60-year old woman was admitted to the hospital for recurrent right lower lobe pneumonia. She endorsed cough with dark green sputum, shortness of breath, drenching night sweats and a 30lb unintentional weight loss in the preceding 6 months. She had a history of recurrent pneumonias for the past eighteen months, with chest imaging that revealed similar right lower lobe infiltration. On physical examination she was afebrile with unremarkable vital signs. Auscultation revealed right lower lobe crackles. Procalcitonin was 0.06 ng/mL and WBC was 10.32. A CT chest demonstrated a right lower lobe infiltrate and possible endobronchial lesion. (Figure 1) Due to concern for endobronchial mass, bronchoscopy was performed which revealed a mobile obstructing mass in the right lower lobe that was retrieved with forceps. There was moderate amount of purulent secretion distal to the obstruction. (Figure 2) Pathology revealed “probable vegetable matter” (Figure 3) and bronchoalveolar lavage (BAL) cultures grew Streptococcus Sanguinis. She was discharged with amoxicillin/clavulanic acid. DISCUSSION: In patients with recurrent pneumonia in the same lung segment, the differential is broad and includes post obstructive pneumonia (POP), ”non-resolving pneumonia” (due to infectious and non-infectious causes) and aspiration. In patients with POP, the most common etiology of obstruction is malignancy, including malignant and benign tracheobronchial tumors. [1,3] The microbiology is diverse and spans gram positive, gram negative and anerobic bacteria thus broad coverage is often initially indicated. [2] Features that distinguish POP from CAP include a lower likelihood of leukocytosis, bandemia, elevated procalcitonin, or fever. With POP there is often >5% weight loss and have increased duration of symptoms. [1] Foreign body aspiration in adults occurs with swallowing disorders of varying etiologies and in states of impaired consciousness. Food causes a more prominent inflammatory reaction (acute and chronic bronchus inflammation in our patient) compared with inorganic objects. CONCLUSIONS: In a patient with recurrent pneumonia in the same lung segment with constitutional symptoms consider post obstructive pneumonia. Workup and treatment includes CT imaging, bronchoscopy and antibiotics. Reference #1: Abers, M.S., et al., Postobstructive Pneumonia: An Underdescribed Syndrome. Clin Infect Dis, 2016. 62(8): p. 957-61. Reference #2: Rolston, K.V.I. and L. Nesher, Post-Obstructive Pneumonia in Patients with Cancer: A Review. Infect Dis Ther, 2018. 7(1): p. 29-38. Reference #3: Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis. 2016;8(11):3401–3413. DISCLOSURES: No relevant relationships by Giuliana Cerro, source=Web Response No relevant relationships by George Chaux, source=Web Response No relevant relationships by Michael Lewis, source=Web Response No relevant relationships by Jason Wong, source=Web Response

Foreign Body Aspiration in Adult: Removing Aspirated Foreign Body using Flexible Bronchoscopy in Emergency Department

Foreign Body Aspiration in Adult: Removing Aspirated Foreign Body using Flexible Bronchoscopy in Emergency Department

Dentures that keeps airway patent: a case report

<p class="abstract">Foreign body aspiration is a life-threatening condition that requires immediate attention and intervention. Foreign body aspiration in adults usually occurs during dental procedure or motor vehicle trauma. Classical symptoms include choking, cough, haemoptysis, hoarseness or stridor. This case report presents an incident of a foreign body lodged at the subglottic region in an adult wearing dental prosthesis; the main complaint was hoarseness post motor vehicle accident. High index of suspicion coupled with correct investigation will facilitate the diagnosis of a foreign body in the airway thus immediate intervention can be taken to prevent morbidity and mortality.</p>

SUCCESSFUL REMOVAL OF A DENTAL CROWN WITH CRYOTHERAPY AND RIGID BRONCHOSCOPY

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Aspiration of foreign bodies occurs most frequently in extremes of age, and these bodies are commonly lodged in the segment of the right middle lobe.1 Foreign body aspiration in adults is associated with such risk factors as alcoholism, drug abuse, mental retardation, and neuromuscular conditions. The most common foreign bodies aspirated are food and broken fragments of teeth.1,2 Foreign body aspiration can cause such complications as atelectasis, obstructive pneumonitis, bronchial stenosis, and endobronchial actinomycosis.3 CASE PRESENTATION: Our patient is a 47yo M with a known history of epilepsy who presented after his primary care physician found a foreign body on chest x-ray (CXR). One year prior to presentation he had a seizure and a dental crown was dislodged from his front tooth. He immediately experienced wheezing, and minor shortness of breath, but this resolved within days. Nine months later he began to have chest pain, worse in the mornings and with inspiration, moderate in severity, and associated with cough and fever. He was treated with multiple rounds of antibiotics as an outpatient for presumed bronchitis. CXR revealed what was believed to be his crown and a right upper lobe post-obstructive pneumonia. He underwent flexible bronchoscopy, which noted complete occlusion of the entrance of the right upper lobe with granulation tissue surrounding the crown. In order to facilitate the removal of the foreign body, rigid bronchoscopy was used. Forceps failed to grasp the crown, and it was successfully removed with the cryoprobe. During the retrieval the crown was dislodged and moved to the right lower lobe where it was finally removed from the patient. He was noted to have purulent drainage coming from the right upper lobe after removal of the foreign body. He did present to the emergency room three days later for pneumonia and acute hypoxemic respiratory failure. CXR noted diffuse interstitial infiltration and he was admitted for treatment. DISCUSSION: Cryoadhesion has been an effective means of removing foreign bodies, and this modality has been successful with various objects. The cryoprobe has been shown to be most useful with objects that have a high water content given to its ability to obtain sub-zero temperatures in a matter of seconds. CONCLUSIONS: Rigid bronchoscopy has benefit over flexible for centrally located foreign bodies, large amount of granulation tissue, or objects that require manipulation. Complications from rigid bronchoscopy include pneumothorax, bleeding, and hypoxia. Patient selection and the skill level of the operator are crucial in preventing adverse outcomes.2 Reference #1: Oke V., Vadde R., Munigikar P., et al. Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital. Journal of Community Hospital Internal Medicine Perspectives. 2015;5(5):28589. Reference #2: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: Presentation and management in children and adults. Chest. 1999;115:1357–62. Reference #3: Folch E, Mehta AC. Foreign body aspiration and flexible bronchoscopy. In: Flexible Bronchoscopy. 3rd edition: Wang KP, , Mehta AC, Turner JF. Chichester, Wiley-Blackwell. 2012, pp 238–49. DISCLOSURES: No relevant relationships by Benjamin Batson, source=Web Response No relevant relationships by Ximena Solis, source=Web Response No relevant relationships by Andres Yepes, source=Web Response

Clinical features and treatment outcomes of airway foreign body aspiration in adults.

There are few reports comparing flexible and rigid bronchoscopy in adult foreign body (FB) aspiration. The aim of this retrospective study was to review the clinical characteristics, outcomes and factors associated with success in adult patients who underwent flexible or rigid bronchoscopy for airway FB removal. We retrospectively reviewed the records of 103 patients who underwent bronchoscopy to remove airway FB at Samsung Medical Center, South Korea from January 1999 to March 2017. The median patient age was 64 years, and 70% were males. Among the 54 patients who underwent flexible bronchoscopy as first-line treatment, 43 (80%) patients had their FB successfully removed. Previous attempts at other hospitals was significantly associated with failed flexible bronchoscopy [9/11 (82%) vs. 3/43 (7%), P<0.001]. Delayed diagnosis (median 29 vs. 5 days, P=0.074) and peripherally located airway FB [9/12 (75%) vs. 23/48 (48%), P=0.115] were factors that trended towards flexible bronchoscopy failure. All of the 59 patients who underwent rigid bronchoscopy had their FB successfully removed. Rigid bronchoscopy was preferred to flexible bronchoscopy in patients with no comorbidities [38/59 (64%) vs. 18/44 (41%), P=0.018], previous attempts at other hospitals [34/59 (58%) vs. 4/44 (9%), P<0.001], delayed diagnosis (median 162 vs. 5 days, P<0.001), and hard FBs [48/62 (77%) vs. 21/49 (43%), P<0.001]. Our data suggest that previous failed attempts and delayed diagnosis are associated with flexible bronchoscopy failure. However, rigid bronchoscopy could be effective in removing an airway FB even in these cases. Further studies to identify factors to facilitate optimal patient selection will minimize failure rates and optimize resource utilization.

Foreign Body Aspiration in Adult, What Would You Expect? Case Report

Foreign body (FB) aspiration is an uncommon but potentially life-threatening event, while the majority of accidental aspiration events occur in children, adults represent up to 25% of cases. When the diagnosis is not established immediately, retained FBs may lead to recurrent pneumonias, bronchiectasis, recurrent hemoptysis, pneumothorax, lung abscesses, pneumo-mediastinum, or other complications. Extraction of aspirated FBs should be undertaken as soon as possible to alleviate acute symptoms and prevent long term complications. FB aspiration is slightly more common in males. The vast majority of adult patients with FB aspiration have obvious risk factors for aspiration including neurological deficits with swallowing difficulties or altered mental status, neuromuscular disease, intoxication, or have an iatrogenic cause. Still, 10% of adult patients with FB aspiration have no known risk factors. Our case is 35 y old male patient who was brought to Accident and Emergency department after being found unresponsive in the street, on arrival to hospital his GCS was 9/15 with pin points pupils , spontaneous breathing and hemodynamic stable . CT brain was unremarkable Patient failed to respond to repeated doses of naloxone and his GCS dropped with episode of apnea so was intubated and mechanically ventilated. Follow up chest x-ray show opacification of the right lung, and ABG reveled hypoxia with respiratory acidosis in spite high ventilator settings, So CT chest was the best option which reveled bronchial obstruction mostly due to foreign body. Urgent bronchoscopy was done and unexpectedly obstruction was due to chewing gum pieces, aspiration of four large pieces of chewing gum, following that patient remained in the ICU for 2 days where chest x-ray show significant improvement and he was weaned and extubated successfully.

Celebration gone wrong: A case of foreign body ingestion related to a military promotion ceremony

Introduction: It has been reported that every year, over 1500 deaths have been attributed to foreign body aspiration in adults. Most foreign body ingestions in adults occur during eating, while in the pediatric population, toys and magnets are the common culprits. Delay in diagnosis is common given that patients may only present with a cough and be mislabeled as having asthma or an upper respiratory infection. As a result, a high index of suspicion for foreign body aspiration must be present to allow for timely identification and treatment. If noted to be in the gastrointestinal tract, endoscopy is often employed due to its reported 95% successful retrieval rate. case report: We present a case of 26-year-old active duty soldier who was found to have aspirated a foreign object during a promotion ceremony. Urgent endoscopy with a roth net was utilized and successful in removing the object. conclusion: Initial evaluation should focus on the patient’s respiratory status to include choking, drooling, wheezing, and bloody saliva to determine if urgent intubation is required for airway protection. While in the past, foreign object removal required a surgical procedure, endoscopy has now stepped up as a suitable noninvasive alternative in many cases.

Foreign Body Aspiration in Adult: Analysis of 28 Cases

Objective: The aim of our study is to discuss our experience with foreign body aspirations in our Interventional Pulmonology Unit. Methods: Patients who were referred to our Interventional Pulmonology Unit between January 2008 to November 2014 for foreign body aspiration and whom foreign body was sentential by intervention were included. Data were used from a retrospective analysis. Results: From the 28 patients, 64.3% of them were women and mean age of the patients were 43.5±21.54 years. Most common presenting symptom was cough (96.3%). Half of the patients were presented in 24 hours after the procedure. From the 5 patients that have undergone diagnostic broncoscopy by fiberoptic bronchoscope, foreign body was removed in 3 of them. Rigid bronchoscopy was done in 25 (89.3%) of the patients. In 3 of the patients foreign body cannot be detected by bronchoscopy and removed by surgery. 67.9% of the foreign bodies that were removed were inorganic in nature.

Does Foreign Body Aspiration Mislead the Doctor? Three Different Case Presentati-ons of Foreign Body Aspiration in Adults

Does Foreign Body Aspiration Mislead the Doctor? Three Different Case Presentati-ons of Foreign Body Aspiration in Adults

Foreign Body Aspiration in Adults and in Children

Foreign body (FB) inhalation is a potentially life-threatening emergency also in clinically stable patients as the situation could worsen at any moment. There is varying opinion regarding the urgency for removal of inhaled FBs, and there are no guidelines in the literature. The aim of our study was to present our experience with FB aspiration in children and adults from 1993, when we introduced our Thoracic Endoscopy Service with the availability "on call" of a bronchologist 24 hours a day, 7 days a week, defining a dedicated protocol together with our anaesthesiologists for prompt intervention in this situation. We consulted our database and examined the records of all patients undergoing bronchoscopy for suspected FB aspiration from 1993 onwards; our previous experience of 11 children and 14 adults with FBs from 1981 to 1992 was also included to compare the results obtained. In this period, we removed 159 FBs (in 70 children and 89 adults) and performed 23 negative bronchoscopies in children and 6 in adults for suspected aspiration. All FBs were removed successfully. We were able to intervene immediately also in critical situations: in 60/70 children within 24 hours of admission to hospital, in 44 of these 60 on the actual day of admission, thus avoiding a potentially dangerous delay between aspiration and removal. We had no complications, and no patients needed surgery. We conclude that an efficient organization involving a dedicated protocol of intervention, trained staff available 24 hours a day, 7 days a week, appropriate setting, and the right instrumentation enabled us to tackle this important emergency.

Chronic Cough and Foreign Body Aspiration in Adults

Chronic Cough and Foreign Body Aspiration in Adults

Foreign‐Body Aspiration in the Adult: Presentation and Management

Nonasphyxiating foreign-body aspiration in adults can be difficult to diagnose because the symptoms are nonspecific and chest x-rays may be normal due to organic composition of the foreign bodies. The diagnosis is often made via flexible bronchoscopy; however, debate remains as to whether rigid or flexible bronchoscopy is the optimal method of extraction. The authors describe a patient who was initially referred for assessment of a calcified left mainstem bronchus mass identified only on computed tomography scan of the thorax. The patient underwent flexible bronchoscopy and was discovered to have a bone fragment wedged in the bronchus for a duration of 22 years, which was successfully removed via rigid bronchoscope.

Longstanding Tracheobronchial Foreign Body in an Adult

Foreign body aspiration in adults usually occurs in the elderly or in patients with underlying neurological impairment, excessive alcohol consumption, psychiatric diseases, Alzheimer disease, or head trauma.[1][1] Foreign body aspiration in young adults without these risk factors is rare, and