Presentation Of Foreign Body Aspiration Research Articles

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

Variable Presentation of Foreign Body Aspiration in Children: Diagnostic Dilemma

Aim: To determine the frequency of common clinical presentations in children with foreign body aspiration.
 Methodology: This cross sectional study was done during the period of March, 2017 to Feb, 2018 A total of 84 children with history of foreign body aspiration were included. The data was entered in the proforma which includes history and the common presentation. The study was approved by ethical review board of PUMHSW. Written informed consent was taken from parents/guardian of all participants.
 Results: The average age of the children was 3.2±1.69 years. There were 52(61.9%) male and 32(38.1%) were female. Frequency of common clinical presentation was repeated attacks of cough 64.3%, respiratory distress 64.3% followed by sudden onset of choking 54.8%, non-responsive to treatment 34.5%, cyanosis 11.9% and with decrease air way breath sound in right and left as well as bilateral lung was 44%, 23.8% and 16.7& respectively. 46.4% had right, 22.6% left and 25% bilateral hyperinflation similarly 17.95 right, 15.5% left lung were collapse.
 Conclusion: Beetle nut as foreign body inhalation is more common in children. Repeated attacks of cough, respiratory distress, and chocking are the commonest symptoms. FBA should be kept in differential diagnosis of persistent cough in children.

Pneumonectomy in a child due to belated diagnosis of foreign body aspiration: a case report

IntroductionWith early diagnosis, fiberoptic or rigid bronchoscopy methods are the gold standard in the management of tracheobronchial foreign body. Otherwise, nonrecognized bronchial foreign bodies cause irreversible damage to the airways and lungs. The deficiency of the health system noted in many developing countries such as Madagascar, combined with the fundamental problem relating to children’s conditions, which are determined by social and educational factors, makes it almost impossible to provide early and appropriate management of the penetration syndrome.Case presentationAn 11-year-old Malagasy female patient was referred to our hospital for an investigation of the etiology of the patient’s hemoptysis. The investigations revealed a localized bronchiectasis and atelectasis due to a foreign body obstructing the left main bronchus. Based on the hemoptysis and left lung almost destroyed by an occlusive lesion within, we decided to proceed with left pneumonectomy. A retrospective interrogation revealed a choking episode 4 years prior in elementary school after the child sucked on a pen cap and involuntarily aspirated it. Two years after the pneumonectomy, our patient was doing well and was asymptomatic.ConclusionIn this case report, we describe a rare case of a late presentation of foreign body aspiration that resulted in a left pneumonectomy in a child. Despite our favorable results, pneumonectomy must be the preferred last option. Preventive actions remain the optimal approach.

KERNEL OF TRUTH: AN INTERESTING CASE OF FOREIGN BODY ASPIRATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Foreign body aspiration (FBA) is commonly seen in the pediatric and elderly population. Risk factors include encephalopathy, stroke, alcoholism and neuromuscular disorders affecting swallowing reflex. It is rare in the adult population except in cases of unconscious accidental ingestion. The most common symptom of FBA is chronic cough, which is nonspecific and can often be mistakenly approached as an infectious process. Here we describe a case of a patient who had no significant risk factors, presented with chronic cough and was found to have a lung mass on imaging but ultimately diagnosed with foreign body aspiration. CASE PRESENTATION: A 60-year-old male presented to the pulmonary office for a progressive productive cough of two-year duration. Chest roentgenogram (CXR) showed a dense opacification in the right middle lobe concerning for pneumonia versus obstructive lesion. He completed a 10-day course of levofloxacin but with no improvement of symptoms. He denied history of travel, sick contacts, pet exposure, or incarceration. He had intermittent febrile episodes and a twenty-pound weight loss. He was a non-smoker and didn’t drink alcohol. On physical examination, he had decreased breath sounds on the right lung field. Laboratory workup was significant for leukocytosis. Chest computed tomography showed complete opacification of the right middle lobe (RML) with abrupt cut off of the RML bronchus concerning for an obstructive mass along with subcarinal and right hilar lymphadenopathy (Figure 1). He underwent diagnostic bronchoscopy in which two yellow, spherical foreign body fragments were found to be obstructing the RML bronchus (Figure 2). Both specimens were removed successfully, and further gross examination was consistent with corn kernels. Bronchoalveolar lavage and endobronchial biopsies were negative for malignancy. After foreign body removal, patients' symptoms subsequently improved. DISCUSSION: FBA in the tracheobronchial tree is more common in the pediatric population than adults. Common risk factors in adults include advanced age, stroke, neuromuscular diseases such as myasthenia gravis, and alcohol abuse. Given the lack of such risk factors, prolonged duration of symptoms, and imaging concerning for malignancy, the diagnosis of FBA was not suspected. Undiagnosed FBA can lead to complications such as recurrent pneumonia, atelectasis, or bronchiectasis. Flexible bronchoscopy is the treatment of choice for the diagnosis and removal of FBA. CONCLUSIONS: Due to the predisposition for a delayed diagnosis of FBA in the healthy adult population, a high index of suspicion and thorough history taking is warranted when dealing with cases of chronic cough and recurrent pneumonia to avoid long term sequelae. Reference #1: Kam JC, et al. Foreign Body Aspiration Presenting with Asthma-Like Symptoms. Case Reports in Medicine. 2013;2013:1-4. Reference #2: Cataneo AJM, Reibscheid SM, Ruiz RL, Ferrari GF. Foreign Body in the Tracheobronchial Tree. Clinical Pediatrics. 1997;36(12):701-705. Reference #3: Malinowska E, Dabrowska-Kruszewska J, Doboszynska A, Stangiewicz M, Gugala K, Biernacki M. Foreign Body in the Airway a Female Patient with Myasthenia Gravis. Advances in Experimental Medicine and Biology Pathophysiology of Respiration. 2015:29-36. DISCLOSURES: No relevant relationships by Anthony Cucci, source=Admin input No relevant relationships by NICOLE LAO, source=Web Response No relevant relationships by Joseph Michael Lim, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response

Delayed Presentation of Foreign Body Aspiration in An Adult Requiring Lobectomy

Foreign body FB aspiration in adults is usually associated with predisposing risk factors like old age alcohol and or sedative abuse obtunded neurological status psychiatric illness or poor dentition Generally the manifestations of the symptoms of FB aspiration are immediate We present a case of unsuspected FB aspiration in an adult female with no predisposing factors who presented with recurrent pnuemonitis after years of aspiration Failure to remove the embedded foreign body endoscopically on multiple attempts necessitated lobectomy under balanced general anesthesia technique

Foreign Body Aspiration Presenting as Life - Threatening Bronchial Asthma

A two-year-old male, a known case of bronchial asthma was admitted as a case of exacerbation of asthma. He did not improve with standard treatment and required invasive ventilator support twice during his admission. The chest x-rays only showed hyperinflation but CT scan of the thorax revealed a foreign body (a piece of Betel nut) lodged in the right main bronchus. It was removed under bronchoscopic guidance.

Traumatic gunshot wound to the larynx with subsequent aspiration of the bullet

Penetrating trauma to the neck, laryngeal fracture and foreign-body aspiration are three injuries that, individually, infrequently occur in adults. Reports of penetrating neck injuries and foreign-body aspiration presenting simultaneously, have been described in the literature. The authors present the previously unreported case of a penetrating gunshot wound to the pharynx with resulting laryngeal fracture followed by aspiration of the bullet in an adult patient. In this case, appropriate treatment of the neck injuries must be prioritized along with locating and removing the aspirated foreign body.

Unusual Presentation of Foreign Body Aspiration as Pleural Effusion in an Infant

To the Editor : Foreign body aspiration presenting as isolated pleural effusion without an underlying pneumonia is rare. So far only one case has been reported [1]. An 11-mo-old boy presented with a history of sudden onset of fast breathing and retractions since last 4 h. He was hemodynamically stable with 95 % saturation under hood oxygen. Auscultation revealed decreased air entry on the left side. Chest radiography showed pleural effusion with collapse lung on left side with ipsilateral mediastinal shift. Ultrasound chest showed left sided pleural fluid of 6 mm depth. Diagnostic pleural tap showed a transudative fluid with no pus cells or bacteria. Total blood WBC count was 18,600 with 78 % polymorphs. The child had a fever spike of 101 °F 2 h after admission. Hence, a possibility of community acquired pneumonia with synpneumonic effusion was kept and child was started on intravenous ceftriaxone. After 48 h of treatment, the child’s respiratory distress did not improve and air entry was persistently decreased on the left. Blood culture and pleural aspirate culture were sterile, no further fever spikes. Repeat chest radiography showed a partially expanded lung with only minimal blunting of costophrenic angle on the left and hyperinflated lung on the right. Hence, on clinical grounds, a diagnostic fibreoptic bronchoscopy was done which revealed a Bengal gram piece in the left intermediate bronchus. Urgent rigid bronchoscopy was done and two pieces of Bengal gram were removed from the left intermediate bronchus. Post procedure the child was treated with intravenous steroids and adrenaline nebulisation. The child showed dramatic improvement, respiratory distress settled. Repeat chest radiography 12 h later was normal. Blood counts normalised to a total count of 10,600 with 63 % polymorphs and the child was discharged after 48 h. There is a case report of a 60-y-old man presenting with pleural effusion due to a candy wrapper aspiration [2]. But the effusion was secondary to pneumonia. Foreign body aspiration presenting as isolated pleural effusion is rare. So far only one case has been reported, a 3-y-old child with a vegetable foreign body presented with pleural effusion without pneumonia [1]. 750 mL of transudative pleural fluid was drained and the vegetable matter was removed by bronchoscopy. The exact mechanism is not known. The possible mechanisms are either it may be a result of an inflammatory response to a foreign body in the bronchus or it is secondary to the atelectasis and the sudden more—negative intrathoracic pressure. To conclude, in our case, poor response to conventional treatment, persistently decreased air entry and differential inflation even after the resolution of pleural effusion prompted us to investigate for a possible foreign body aspiration. This possibility should always be considered in any child presenting with respiratory symptoms not responding to conventional management.

Foreign Body Aspiration Presenting with Asthma-Like Symptoms

Aspiration of a foreign body into the tracheobronchial tree is rare in adults. In the majority of these cases there is an underlying condition such as mental retardation, depressed mental status, impairment in the swallowing reflex, neurological impairment, alcohol or sedative abuse, or complications from dental manipulations that contributed to the aspiration. These patients are commonly misdiagnosed with asthma and typically do not respond to mainstay anti-inflammatory and/or bronchodilator therapy. We describe the case of a patient with a foreign body aspiration in the upper trachea not recognized by radiographic studies that presented with asthma-type symptoms.

Late presentation of foreign body aspiration requiring extracorporeal membrane oxygenation support for surgical management

We present the case of a near fatal aspiration of a foreign body requiring extracorporeal membrane oxygenation (ECMO) support. The use of ECMO to support treatment for a foreign body in the distal trachea is rare and there are only two cases reported in the literature. A 13-year-old male presented with a three-weeks' history of a cough and swinging fevers. Subsequent investigation revealed a foreign body causing collapse of the right middle and lower lobe with abscess formation. On attempted bronchoscopic removal, copious amounts of pus were aspirated, soiling both lungs. The patient became severely hypoxic and hypotensive. He was unstable on ventilation and inotropes and ECMO was used to stabilise him and facilitate removal of the foreign body and infected lung. He made excellent recovery and suffered no neurological sequalae. This is the first reported use of ECMO support for an acute presentation of a chronic problem. If the patient is too unstable for bronchoscopy, ECMO can be used to temporarily stabilise the patient allowing safe removal of the object. If the patient is acutely unwell and septic, ECMO should be more readily considered.

Persistent Cough and Failure to Thrive: A Presentation of Foreign Body Aspiration in a Child With Asthma

Severe failure to thrive (FTT) in a child with asthma and a persistent cough should not be explained solely by asthma and warrants a thorough and prompt evaluation. The finding of a foreign body in our case was surprising, because it does not usually present as or lead to FTT. Good clinical judgment and habits could prevent the course of events that we described in this case. Following are the key lessons to be learned from this presentation: (1) maintain a high index of suspicion for foreign body aspiration, even in toddlers with asthma, (2) pay special attention to a child with FTT, (3) be aware of localizing findings on physical examination and chest radiographs, and (4) perform a chest radiograph no later than after 1 month of chronic cough.

Foreign body aspiration presenting as croup

AbstractThe differential diagnosis of airway obstruction in the paediatric population is large and in the toddler age group it includes viral croup, bacterial tracheitis, spasmodic croup, laryngeal papillomatosis, retropharyngeal abscess and foreign body aspiration. A case of airway obstruction is presented in which a diagnosis of viral croup was made and in which respiratory deterioration, nearly a week later, necessitated intubation and ventilatory support. Laryngotracheoscopy revealed foreign black material in the subglottis which was initially thought to be an inhaled foreign body but subsequently was identified histologically as stratified squamous epithelium of unknown origin. Aspiration of a foreign body is a great mimicker of viral croup.