Foreign Body Inhalation Research Articles

Un corps étranger bronchique négligé pendant 23 ans

Foreign body inhalation is a clinical emergency requiring prompt action to ensure speedy recovery and minimize the development of complications. It is more common in children than adults. We report a case of a neglected foreign body present in the bronchus of an adult for 23years and treated as intermittent asthma. The diagnosis was revealed following the development of severe sepsis of a pulmonary origin. The foreign body was removed by rigid bronchoscopy, antibiotic therapy instituted and pre- and post-interventional respiratory physiotherapy carried out. Satisfactory progress was marked by the complete clearing of pulmonary suppuration, with only a small localized and asymptomatic focus of bronchial dilatation remaining. The persistence of chronic, unexplained respiratory complaints should prompt the use of imaging and endoscopy to exclude an endobronchial cause, especially to consider the possible presence of a previously unknown foreign body. Early diagnosis and intervention can help to avoid potentially serious complications.

Tracheobronchial Foreign Bodies: The Importance of Timely Intervention and Appropriate Collaboration.

The aim of study is to determine epidemiological profile of the cases suspected to have laryngotracheobronchial foreign body, average interval between onsets of symptoms and presentation to our tertiary centre, average interval between admission and active surgical intervention, incidence of various clinical, radiological and intraoperative findings. All patients presenting to our institution with suspicion of foreign body inhalation who underwent rigid bronchoscopy from October 2012 to April 2018 were considered for this study. Data compilation of these patients was done which included age, sex, chief complain, time of onset, time of presentation to hospital, time till intervention was undertaken, clinical and radiological findings, nature of foreign body, history of ingestion, intraoperative findings and post-operative recovery. All these aspects were then evaluated. Our study included 89 cases who underwent rigid bronchoscopy under General Anaesthesia. 67.4% were male and 71% were children less than 2years of age. 36% presented within the first 48h and 64% of these were managed within 24h of presentation. Of these 50.6% gave history of foreign body inhalation and cough was the most common presentation in 92.1%. Collapse was the most common radiological finding in 42.7% cases. Lodgement of foreign body was slightly more on right side (45.5%). Most of the foreign bodies were of vegetative nature-84.7%. There was no mortality out of all 89 cases. Although the mortality and complication rate has decreased significantly after the advent of endoscopically assisted bronchoscopy, still attention needs to be given to earlier diagnosis of foreign body aspiration and earlier referral to an ENT surgeon for bronchoscopy if required. Also the time duration between intervention to be undertaken from the time of symptom onset can be decreased with a better collaboration between the Radiologist, the Paediatrician and the Otorhinolaryngologist.

Yields of Bronchoscopy and Bronchoalveolar Lavage in Diagnosis of Undefined Persistent Wheezy Chest Among Children

Background: Wheezing in infants and children is a common problem presented to primary care offices. Approximately 25 to 30 percent of infants will have at least one episode of wheezing. By three years of age, an episode of wheezing will have occurred in 40 percent of children, and by six years of age, almost one half of children will have at least one episode of wheezing. Most infants and children with recurrent wheezing have asthma, but other causes should be considered in the differential diagnosis. The most common diagnoses in children with persistent wheezing are asthma, allergies, gastroesophageal reflux, infections, foreign body aspiration and bronchopulmonary dysplasia. Objective: the present study was designed to evaluate the clinical role of different types of bronchoscope and bronchoalveolar lavage in diagnosis of undefined persistent wheezy chest among the age group from 6 months to 14 years, at Al-Azhar University Hospitals in Cairo. Patients and Methods: This a prospective study was conducted on 50 children complaining from different respiratory problems who had enrolled consecutively from the Outpatient Clinic and the Inpatient Pediatric Department of Al-Azhar Faculty of Medicine University Hospitals (AL-Hussein and Bab-Elshareya), from January 2017 to December 2018. Patients ages ranged between 6 months and 14 years. Results: as regard distribution of patients according to post bronchoscopy diagnosis, the study showed that foreign body inhalation n16 (32%), Chronic aspiration n9 (18%), tracheobronchomalacia n2 (4%), bronchial mass n1 (2%), streptococcus pneumonia n7 (14%), hemophilus influenza n2 (4%), staphylococcus aureus n3 (6%) and pseudomonas aeuroginosa n2 (4%), candida albicans n1 (2%), Mycobacterium TB n1 (2%). Conclusion: It could be concluded that if radiography is normal and the child continues to wheeze, bronchoscopy should be the next step, the bronchoscope is a valuable tool in the diagnosis and treatment of airway disorders in children. It has a good safety profile with rarely reported life threatening or long-standing complications.

Nasal foreign bodies among pediatric population in Zaria-Nigeria

Background: Nasal foreign body (FB) is a common reason for presentation to the emergency units and the Otorhinolaryngologist. Objectives: To report the pattern and management of pediatric nasal FBs in Ahmadu Bello University Teaching Hospital Zaria. Methodology: The records of patients managed for nasal FBs over a 5-year period between January 2013 and December 2017 were reviewed. Data obtained for this study included demographic characteristics such as age, sex, type of FBs, laterality or bilaterality, method of removal, and presence or absence of complications. The data were analyzed using Statistical Product and Service Solution version 23.0. Results: There were 48 (55.8%) males and 38 (44.2%) females with male-to-female ratio of 1.3:1. The mean age was 3 years with standard deviation of ±1. In total, 76 (88.4%) of the patients were between 1 and 4 years of age. Beads (30, 34.9%) and foam (15, 17.4%) were the most common FBs inserted into the nose in this study by the patients. Among the different nasal FB, there were 57 (66.3%) inorganic FBs and 29 (33.7%) organic FBs. Right nasal cavity (43, 50%) was the most common site of lodgment in this series followed by the left nasal cavity (43, 48,8%). Nasal FB were removed in the clinic using instruments in 85 (98.8%) cases. Conclusion: Children between 2 and 4 years are more prone to nasal FB inhalation. There is the need for increased awareness among the parents who use beads for decoration or worship and indiscriminate disposal of button batteries.

Factors Influencing Prognosis in the Endoscopic Extraction of Foreign Bodies in Kashmiri Population

An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.

Competence in pulmonary endoscopy emergencies.

In clinical practice, interventional pulmonologists face several situations which can lead to dramatic consequences especially regarding ventilation and require immediate intervention. We describe the main pathological conditions where an urgent bronchoscopy is crucial because they act through mechanisms such as airway obstructions or alteration of the anatomic integrity of the tracheobronchial tree. We point out the problems resulting from inhalation of foreign bodies, one of the most dramatic respiratory emergencies typical in childhood which needs not only the appropriate endoscopic equipment suitable for the age, but also great experience in the management of the possible related complications. Massive hemoptysis is then discussed in order to help to choose the right endoscope and to clarify the steps requested to face this dramatic event. Lastly, iatrogenic tracheal injuries are described, in spite of their low occurrence. The correct endoscopic assessment of the lesions enables to select the proper multidisciplinary therapeutic approach together with surgeons and anesthetists. Due to their peculiarities, emergencies do not allow classic training so it is difficult to estimate the procedure volume necessary to achieve an adequate endoscopic experience. We think, in this field, it is advisable to refer to numbers proposed for elections endoscopic procedures. For these reasons, we consider desirable the use of simulators and clinic case discussions during interventional pulmonologist's training.

MAGNESIUM OXIDE PILL ASPIRATION: CASE REPORT

SESSION TITLE: Medical Student/Resident Procedures SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pill aspiration is uncommon in adults, comprising 2.8% of foreign body aspirations. Symptoms and signs are nonspecific and chest x-rays can be normal in 25% of cases. It can cause airway obstruction, inflammation and stenosis leaving long-term sequelae. Having a high suspicion and doing bronchoscopy early is important in avoiding any long-term sequelae. Here we report a challenging case of bronchus obstruction by magnesium oxide pill aspiration. CASE PRESENTATION: A 60-year-old female presented to the emergency department (ED) at an outside hospital with irritation and cough after choking on a magnesium pill. Chest x-ray did not show any abnormalities so patient was discharged home with instructions to follow up with her primary care physician (PCP). Over the next 2-3 days, she had low-grade fever, coughing fits which brought up bits of the tablet and shortness of breath. She saw her PCP the next day and was given azithromycin. That night, she had a fever of 38.8C and came in to our ED. Vital signs were stable except for oxygen saturation of 91% on room air. She had decreased breath sounds on right mid-to-lower lung field. The remainder of her exam was unremarkable. Chest x-ray showed right middle lobe infiltrates. CT chest revealed a 9x9mm radio-opaque density in the right bronchus intermedius, scattered areas of ground glass opacities and atelectasis in the right middle lobe. She underwent flexible bronchoscopy that showed a white ball-like foreign body near-obstructing the right bronchus intermedius. Mucosa was edematous with mild inflammation, no necrosis or stenosis was noted. The foreign body was successfully removed with grasping forceps in a few smaller pieces (biggest 9 x 7 mm). They were hard, white and chalky, consistent with the magnesium oxide pill. The next day, she reported improvement in her cough and shortness of breath. Her oxygen saturation had improved to 96% on room air and she was discharged home in stable condition. DISCUSSION: Adult patients can present with a clear history of the aspiration event. Symptoms and signs are nonspecific and chest x-rays can be normal in 25% of cases, making the diagnosis challenging. Our patient felt the choking sensation and sought medical attention. Despite her history and due to normal chest x-ray and nonspecific symptoms of cough and normal vital signs, she was initially discharged home without further investigation. In the cases where patients remember a specific aspiration event, despite nonspecific symptoms and normal chest x-ray, further investigation with CT imaging or bronchoscopy should be sought. Left untreated it is possible that there may be further damage to the bronchus through inflammation. CONCLUSIONS: There has been no documentation of the effects of magnesium oxide pill aspiration on the bronchial mucosa. Early bronchoscopy with intervention to remove the pill is important in avoiding any long-term complications. Reference #1: Singh I, Dm S, Dm SD, Ram B. Foreign Body Inhalation in the Adult Population : Experience of 25 , 998 Bronchoscopies and Systematic Review of the Literature. 2015:1438-1448. https://doi.org/10.4187/respcare.03976. Reference #2: Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. “ Pills ” and the Air Passages, A Continuum. Chest. 2015;147(1):242-250. https://doi.org/10.1378/chest.14-0531. Reference #3: Kinsey CM, Folch E, Majid A, Channick CL. Evaluation and Management of Pill Aspiration. CHEST. 2013;143(6):1791-1795. https://doi.org/10.1378/chest.12-1571. DISCLOSURES: no disclosure on file for Ji Hyun Rhee; No relevant relationships by Jack Tomen, source=Web Response

"AIR LEAK SYNDROME": An Unusual Presentation of Foreign Body in the Airway.

Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway.

Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality.

IntroductionAsphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the United States (U.S.) and to identify factors associated with mortality in this population.MethodsWe conducted a retrospective cross-sectional study using the 2013 U.S National Emergency Department Sample database. ED visits with primary diagnoses of intentional or accidental suffocation injury, and injury by inhalation and aspiration of foreign bodies or food (ICD-9-CM codes) were included. We performed descriptive statistics to describe the study population. This was followed by multivariate analyses to identify factors associated with mortality.ResultsWe included a total of 27,381 ED visits for suffocation injuries. Most suffered from either inhalation and ingestion of food causing obstruction of respiratory tract or suffocation (51.6%), or suicide and self-inflicted injury by hanging, strangulation, and suffocation (39.4%). Overall mortality was 10.9%. Over half (54.7%) of the patients were between 19 and 65 years old. Males were more common than females (59.1% vs. 40.9%). Over half of the patients (54.9%) were treated and released from the ED. Factors associated with increased mortality included male gender, young age (4–18 years), diseases of the cardiac, respiratory, genitourinary and neurologic systems, intentional self-harm, and self-payer status.ConclusionMortality from suffocation injuries remains high with significant burden on children and adolescents and on patients with intentional injuries. Tailored initiatives targeting identified modifiable factors through implementation of behavioral and environmental change can reduce the risk of suffocation injury and improve clinical outcomes of affected victims.

Unusual foreign bodies of the airway: a case series regarding their management

<p>Foreign bodies in the bronchi are a common problem seen by ENT surgeons. Bronchial foreign bodies are common in children because they have difficulty in swallowing hard foodstuffs such as nuts and have an inadequately developed protective respiratory reflexes, which makes them vulnerable to inhalation of foreign bodies This is a case series of four unusual cases of foreign body airway, that presented to our ENT OPD, after taking detailed history and clinical examination, these patients were subjected to radiological studies such as chest X-rays, X-ray soft tissue lateral view, virtual bronchoscopy and CT chest to confirm the foreign body, after taking informed consent rigid bronchoscopy was performed and foreign body extracted.</p>

Le syndrome d’apnées obstructives du sommeil n’est pas mauvais que pour le cœur !

Obstructive sleep apnoea (OSA) is common in the general population, particularly in the elderly. This syndrome is frequently responsible for severe cardiovascular complications. However, the indications for its treatment in the elderly remain controversial. We report the case of a 79-year-old man with severe, undiagnosed OSA who inhaled his fixed dental bridge during sleep. The inhaled foreign body came to rest in the lumen of the left main stem bronchus. The association of obesity with a body mass index of 30kg/m2, snoring with breathing pauses reported by his partner, nocturia, morning headache and an Epworth score of 11 led to polysomnography which confirmed OSA with an apnoea/hypopnoea index of 53 per hour. This case report emphasises that OSA may constitute a risk fact for foreign body inhalation in elderly subjects due to arousal-induced hyperventilation following the apnoeic event.

Anesthesia for Removal of Foreign Bodies in Lower Respiratory Tracts in Souro Sanou University Hospital Center in Bobo-Dioulasso: About 46 Cases

Introduction : The inhalation of foreign body is a common cause of respiratory distress in children. Anesthesia for this endoscopy represents a challenge for the anesthesiologist.
 Objective : To assess the anesthetic management of foreign body extraction of the lower respiratory tracts in a context of limited resources.
 Patients and methods : This is a retrospective study in descriptive aim, over 3 years from 1st January 2014 to 31st December 2016. It involved patients admitted for foreign bodies of the lower respiratory tracts in Resuscitation service and ENT in Souro Sanou University Hospital Center in Bobo-Dioulasso .
 Results : A total of 46 patients were hospitalized for foreign bodies of the lower respiratory tracts during the study period. The mean age of the patients was 2.6 years ± 8.23. Patients were predominantly male with 27 cases (58.70 %), a sex ratio of 1.42. The foreign bodies were of organic type in 82.60% of the cases, against 17.4 % of non organic. The location of foreign bodies was laryngeal in 03 cases (06.52%), tracheal in 06 cases (13.04%) and bronchial in 37 cases (80.43%). The average consultation time was 3.12 days ± 4.7. The circumstances of discovery were a notion of penetration syndrome in 69.57%, respiratory dyspnea in 91.30%, a queasy cough in 56.52% of cases and a chance discovery in 2.17% of cases. . The foreign bodies were radio-opaque in 17.39% of cases. Extraction of foreign bodies was performed under general anesthesia. In intraoperative operating room, incidents / accidents were noted in 23.91 %. Operative follow-up was simple in 82.60% of cases and complications were recorded in 15.21% of cases.
 Conclusion : Foreign bodies of the lower respiratory tracts remain a topical issue for the child. The therapeutic treatment is based on the realization of a Laryngo-tracheo-bronchial endoscopy, under general anesthesia by an experienced crew.

Late presenting foreign body and spontaneous exhalation in children: Myth vs reality

Foreign body (FB) inhalation is frequent in infant and children. Prompt treatment is needed to avoid further complications. We here report two cases of FB right bronchus with delayed presentation. The children had history of FB inhalation which was not properly evaluated initially by their primary physicians. The children were brought to us due persistence of cough, vomiting and difficulty in breathing. Following evaluation, chest x-ray revealed FB in the airway of each of the patients, In both, there was accidental dislodgement of the FB before the specific intervention.

Fatal airway complication during root canal treatment

Foreign body (FB) in the tracheobronchial tree is not uncommon, especially in infants and children. They often present with respiratory obstruction, which can lead to death if not removed in time. Despite public awareness and education, FB aspiration continues to be a problem among patients. We report a case of tracheobronchial FB in a 13-year-old boy who had accidentally aspirated a sharp metallic needle, used during root canal treatment by a dental surgeon. The FB was removed successfully without any complication. FB inhalation is possible while conducting a surgical procedure in the oral cavity. This situation is a life-threatening condition, affecting the patient, and may also create a legal issue to the concerned caregivers. Every clinician should be aware of this type of mishappening during oral cavity procedure.

Frequency of foreign body inhalation in eight month duration admitted in Paediatric intensive care unit of Abbasi Shaheed hospital (tertiary care centre)

We present four cases of foreign body inhalation in eight month period (May-Dec 2016) admitted in pediatric intensive care unit (p.i.c.u) of Abassi Shaheed Hospital. Age range was eleven months to four years. Male gender was predominant among the case series. All of the cases presented with sudden onset of respiratory distress along with fever and cough. On examination all patients were febrile, tachpneic, tachycardic with subcostal and intercostal recessions. A working diagnosis of severe pneumonia was made and child was put on intravenous antibiotics and nebulizations. After 48 hours of admission, there was no improvement clinically so suspicion of foreign body was made on the basis chest of x-ray. Rigid bronchoscopy was done; foreign body peanut (1), chicken bone (1) and betel nut (2) were found. All children showed rapid improvement after removal of foreign body and were discharged soon after. Parents were counseled regarding addiction of betel nut and avoidance of foreign body inhalation in growing children. Hence we conclude that foreign body inhalation should be kept as a differential diagnosis in every child presenting with respiratory distress without improvement despite treatment. Parents should also be counseled for being vigilant around their children. There is no conflict of interest.

Low rate of positive bronchoscopy for suspected foreign body aspiration in infants

ObjectivesTo describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body. Study DesignRetrospective chart review. MethodsA retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed. ResultsSixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection. ConclusionsOur institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases. Level of EvidenceCase Series.

Application of MDCT and post-processing in children with tracheal foreign body

Objective:To explore the clinical value of MDCT and post-processing in children with suspected foreign body in trachea.Method:Two hundred patients with suspected tracheal foreign body were treated with 64-slice spiral CT (MDCT) and simulated endoscopic imaging,then compared with seen in bronchoscopy; Compare the results of MDCT and post-processing with the coincidence of intraoperative findings.Result:One hundred and eighty-four cases of positive children were examined by MDCT postprocessing technique and bronchoscopy,179 cases were obstructed by exogenous foreign body,5 cases were phlegm thrombosis (endogenous foreign body) obstruction; 16 cases of children with no foreign body diagnosed by MDCT post-processing technique were also examined by bronchoscopy. The results showed that there was a foreign body in 1 case,and the foreign body was located in the pharyngeal cleft (watermelon spermoderm),and the remaining 15 cases had no foreign body. MDCT and post-treatment techniques for children with tracheal foreign body diagnosis of 99.4% sensitivity,specificity of 75%.There was no significant difference in the detection rate of foreign body between the two techniques of MDCT and post-processing technique and bronchoscopy (P>0.05). Examed by MDCT and postprocessing,we can understand the specific location and size of foreign body,nature,shape preoperatively.Conclusion:Although MDCT and post-processing techniques can not be used to treat tracheal foreign bodies,but the diagnostic rate of bronchial foreign bodies is comparable to that of bronchoscopy. We could apply MDCT examination and post processing before the bronchoscopy,for foreign body inhalation history is not clear,or suspected airway foreign body. We can improve the level of diagnosis and treatment through guiding the operation of bronchoscopy focus.

Unintentional Injuries In Children: Are Our Homes Safe?

Unintentional injuries are a leading cause of death in childhood globally. Injuries lead to emotional trauma and financial burden for children, parents, and society. Here are the frequencies of unintentional injuries in children presented to the emergency and paediatric surgery clinics of the Aga Khan University Hospital, Karachi, Pakistan, from January to December 2012. Aretrospective chart review of children aged 0 day to 14 years presented with falls, burns, foreign body ingestion or inhalation, poisoning, fingers caught in doors, electrocution injuries and drowning, was conducted. Atotal of 165 children were included. Domestic injuries were frequently occurring injuries in our set-up which could be prevented by doing small adjustments to make the home safe for children.

Laryngo-Tracheo-Bronchial Foreign Bodies in Children: Clinical Presentations and Complications.

Foreign-body (FB) aspiration in the airway of children is a life-threatening clinical situation responsible for many deaths each year. The aim of this study was to evaluate the different clinical presentations, methods of diagnosis, types and complications of FB inhalation in the pediatric age group. The study included patients who presented with a definitive or suspicious history of FB aspiration. Detailed data for each patient were recorded concerning the age, sex, nature and site of the FB, presenting symptoms and signs, and radiological findings. Fifty-six patients were enrolled in this study. The age of patients ranged from 6 months to 14 years, with a mean age of 4.5 years. Sixty percent of patients were under 3 years of age. The time interval between aspiration of foreign body and onset of diagnosis ranged from 2 hours to 5 months. Thirty-four (60.7%) patients had normal chest X-ray findings, while opaque FB was seen in eight patients (14.3%). Signs of bronchitis were seen in five patients (9%), while pneumonia and atelectasis were seen in six (10.7%) and three cases (5.3%), respectively. FB aspiration is a life-threatening clinical situation, with children <3 years of age being most commonly affected. FB aspiration must be considered a matter of emergency, especially in the case of organic FBs. This study aimed to increase the awareness of laryngo-tracheo-bronchial FBs, as early diagnosis and management decrease the incidence of complications and make removal of aspirated FB easier.

A toddler with a cough and wheeze refractory to treatment

A 20-month-old girl weighing 12 kg presented with 2 weeks of worsening dry cough and wheeze. Aside from respiratory symptoms she was otherwise well, without fever or weight loss. There...