Suspicion Of Foreign Body Aspiration Research Articles

96 Foreign Body Aspiration in Children: A Review of the Public Health Prevention Guidelines by Analyzing the Circumstances of Choking Episodes in a Canadian Tertiary Centre from 2006 to 2020

Abstract Background Choking and foreign body aspiration are major causes of morbidity and mortality in infants and young children. To prevent choking episodes and their complications, many associations, from the Canadian Paediatric Society to National Public Health Institutes, have suggested prevention guidelines for parents and health professionals. They specify what types of food should be restricted in young children, such as nuts and raw hard vegetables, and give advice on surveillance. Yet, every year, children are admitted to our centre following a choking episode that requires a bronchoscopy under general anesthesia. Objectives Our objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if public health recommendations are still adequate. Design/Methods This retrospective study included all patients, from 0 to 17 years old, who presented to our tertiary centre between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected from the patients’ electronic files and compared to the prevention guidelines. Results One-hundred and ninety-one patients with a history of suspected foreign body aspiration were included. Among them, 101 had a positive bronchoscopy. Close to 65% of patients were boys. The mean age at presentation was 31,5 months. Food was the most common type of foreign body, causing 73,3% of all choking episodes. Close to 70% of those choking episodes involved nuts, seeds or raw hard vegetables. 84,5% of those events happened at home, and 79,4% of choking episodes happened under the surveillance of one or both parents. Thirty patients ended in the paediatric intensive care unit where they spent an average of 6,47 days. Conclusion Our results show that most choking episodes in children result from a non-respect of actual recommendations. They involve types of food and circumstances that are already restricted by the prevention guidelines. It highlights the need for better parent education and should inspire clinicians to make some time to address choking hazards with families.

Evaluation of the relevance of interhospital transfer medicalization in the suspicion of foreign body aspiration in children

IntroductionForeign body aspiration in preschool children is a common and potentially fatal event. Diagnostic confirmation requires tracheobronchoscopy. The current medical care in West Provence Alpes Cote d'Azur (PACA) is based on an inter-hospital transfer via the emergency medical services (EMS) to the pediatric ear–nose–throat (ENT) reference center in Marseille as quickly as possible. However, the intensive care pediatric transport team has only one vehicle, which is not always available. The issue of the real risk for the suspected patient when they are asymptomatic therefore arises, questioning the presence of a physician during these transports. Main objectiveWe aimed to describe our practice regarding suspected foreign body aspiration (FBA) and assess the relevance of medical transport for children with suspected FBA regardless of their clinical and/or radiological presentation. Material and methodsThis was a retrospective, single-center study at the Timone Children's Hospital, from January 1, 2016, to December 31, 2017. Clinical and radiological data were collected from pediatric emergency files and endoscopy reports. ResultsA total of 178 children were suspected of having FBA upon arrival at the Pediatric Emergency Department of La Timone Children's Hospital; 96 children were transferred from another hospital on pediatric ENT advice. Of these 96 children, 63 were asymptomatic. Of these asymptomatic children who were transferred, 11 did not undergo tracheobronchoscopy and four children presented with a foreign body at tracheobronchoscopy (6%). When transport-related data were available, no deterioration of the clinical condition was described in these patients during transport. ConclusionIn our retrospective study of the medical care for suspected FBA in children in the West PACA region, less than 10% of children who were asymptomatic but suspected of having FBA presented with a foreign body on endoscopy, which questions the relevance of physician presence during transport of these patients.

Pediatrik olgularda uygulanan rijit bronkoskopi işleminde anestezi derlemesinde sugammadeks ve neostigminin etkinliğininin karşılaştırılması

Aim: To compare the efficacy of sugammadex and neostigmine, which are used to reverse rocuronium- neuromuscular blockade in children who underwent rigid bronchoscopy due to tracheobronchial foreign body aspiration.Materials and Methods: The data of 54 patients who underwent rigid bronchoscopy with the suspicion of foreign body aspiration in children aged 0-18 in our hospital between 2013 and 2018 were retrospectively analyzed.Results: Thirty of the cases were male and 24 were female. Atropine-neostigmine was administered to 23 patients and sugammadex was administered to 31 patients to reverse neuromuscular blockade. While no complications were found in 41 cases, bronchospasm was found in 6 cases, hypoxia in 5 cases, and laryngospasm in 2 cases. Recovery time was shorter in patients who received sugammadex (p<0.001).Conclusion: Recovery time is shorter after sugammadex administration in reversing rocuronium-induced neuromuscular blockade in pediatric rigid bronchoscopy anesthesia.

Recomendaciones para la realización de broncoscopia en pacientes pediátricos en la pandemia COVID-19

Introduction: a bronchoscopy is a fundamental tool in respiratory clinical conditions, but it can be a source of transmission of infectious agents such as SARS-COV-2. Therefore, it is urgent to adopt international recommendations for our environment. In this study, we need indications, contraindications, and biosafety measures to perform bronchoscopy in patients with SARS-COV-2 infection.Methods: the first phase consists of an analysis of the state of scientific research with a source of exploration on an academic basis. Subsequently, the elaboration of questions with the PICO methodology, using the PRISMA strategy. These were voted on by 18 Pediatric Bronchoscopist Pulmonologists who answered a survey and defined the agreement strength as strong, moderate and weak, based on expert agreement.Results: the indications with the highest level of an agreement are suspicion of foreign body aspiration and massive hemoptysis. The contraindications with the highest level of an agreement are non-urgent conditions, thermoplasty, stent placement. The general recommendations with the highest degree of agreement are a notification to the anesthesiologist and surgical team. The recommendations during and after the procedure are to use personal protective equipment, proper removal of it, and disinfection of equipment with 75% alcohol.Conclusions: bronchoscopy is a procedure inherent to critical care areas, the high training of the personnel assigned to these tasks is a fundamental principle for the success of its execution. Our project reaches a high level of agreement among the participating experts, which allows the elaboration of the Mexican Bronchoscopy Consensus.

The importance of SARS-CoV-2 testing in pediatric population

Pediatric population associates multiple peculiarities in terms of SARS-CoV-2 regarding the differences of symptoms in comparison to adults, but also the higher incidence of asymptomatic cases. The aim of these case reports is to underline the importance of SARS-CoV-2 testing in pediatric patients. The first case describes the case of a 2-year and nine-month-old child admitted to the Pediatrics Clinic I Targu Mures for involuntary ingestion of toxic substance. The clinical exam pointed out a mild hyperemia of pharynx and small lymph nodes under the mandibula, on the side area of the neck and above the clavicula; and the laboratory tests pointed out leukocytosis, thrombocytosis and one of the liver transaminases above the normal limit. In spite of the presentation concerns, the patient was tested for SARS-CoV-2 infection, with positive result. The evolution was favorable during the admission. The second case describes a 3-year and 8-month-old male patient brought in the emergency department with the suspicion of foreign body aspiration, but the bronchoscopy revealed only purulent secretion in the trachea and bronchia. The RTPCR test for SARS-CoV-2 infection was negative on the admission day, but due to the slowly favorable evolution, the patient was retested on the 5th day of admission, with positive result. The testing of pediatric patients independently of the symptoms and the clinical setting might carry a higher importance in limiting the viral transmission.

Clinico-Radiological Profile and Outcome of Airway Foreign Body Aspiration in Children: A Single-Center Experience From a Tertiary Care Center in Eastern India.

BackgroundForeign body aspiration is one of the leading causes of childhood morbidity and mortality among older infants and toddler age groups. Missed and delayed diagnosis of foreign body aspiration can lead to increased incidence of complications. Early diagnosis can prevent life-threatening complications and morbidity. In this study, we aimed to evaluate the clinical and radiological details, types, localization of foreign bodies, complications, and outcomes in pediatric patients who presented to our hospital with foreign body aspiration.MethodologyWe conducted a retrospective analysis of hospital case records of children aged one month to 14 years who were admitted to the Department of Pediatrics between June 2018 and May 2020, with clinical suspicion of foreign body aspiration.ResultsA total of 22 children with a diagnosis of airway foreign body were included. The mean age of presentation was three years (SD: ±2.22), with a boy-to-girl ratio of 3.4:1. Cough (81.8%) and tachypnea (72.7%) were the most common clinical symptoms. The median duration between symptom onset and diagnosis was three (interquartile range: 6) days. Unilateral reduced breath sound (81.8%) was the most common clinical examination finding. The common site of impaction was the right main bronchus in 59.1% of cases. The foreign bodies retrieved during bronchoscopy were organic substances in 63.6% of cases, with peanuts being the most common (31.8%). Chest radiographs were normal in 36.3% of cases, and common abnormalities included hyperinflation, collapse, consolidation, and mediastinal shift. Mechanical ventilation was required in 54.5% of cases. The mean duration of hospitalization was five (SD: ±2.84) days. Complications such as pneumothorax were seen in one (4.5%) case. Mortality was seen in 4.54% of cases during the bronchoscopic procedures.ConclusionsForeign body aspiration was common in young male children, with cough being the common symptom. Normal X-rays of the chest were seen in one-third of cases. The common site of impaction was the right main bronchus, and organic substances such as peanuts were common foreign bodies retrieved. Strong clinical suspicion of foreign body aspiration should be kept in cases with acute onset of cough in young children. Prompt medical attention is needed to reduce the morbidity and mortality associated with foreign body aspiration.

Predictive Accuracy of Conventional Clinico-radiological Indicators in Foreign Body Aspirations among Children: A Retrospective Study

Introduction: Foreign Body Aspiration (FBA) is a common and serious paediatric emergency condition. A Suspected Foreign Body Aspiration (SFBA) is based on Clinical History (CH), Physical Findings (PF), and Chest Radiograph (RAD/CXR). The predictive accuracy of these factors as indicators of FBA and to perform Rigid Bronchoscopy (RB) based on these factors has been debated. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of clinical history, physical findings and radiology in SFBA. Materials and Methods: A retrospective analysis was conducted on paediatric patients with suspicion of foreign body aspiration, admitted in the Department of Paediatric Surgery at Government Medical College, Thiruvananthapuram, Kerala, India, between January 2006 and December 2020. Factors in CH, PF, and RAD were subjected to univariate and multivariate analysis to evaluate the predictive accuracy of these factors as indicators for bronchoscopy. Sensitivity, specificity, positive and NPV were calculated for the clinico-radiological indicators in predicting FBA. The association between evidence of FBA and clinico-radiological indicators was evaluated by Pearson Chi-square test; and p-values <0.05 were considered to be statistically significant. Results: A total of 458 children (263 males and 195 females) were admitted with SFBA having mean age of 29.49±24.92 months, 389 had confirmed FBA, and 69 had no FBA. The age group of 1-2 years was found to be a statistically significant factor for FBA (p-value=0.03). Foreign Body aspiration Witnessing Event (FBEW) (p-value <0.0001, sensitivity=91%, specificity=31%), choking spell (p-value <0.0001, sensitivity=95%, specificity=25%), acute cough (p-value <0.0001, sensitivity=87%, specificity=46%), tachypnea (p-value <0.0167, sensitivity=89%, specificity=20%), decreased breath sound (p-value <0.0001, sensitivity=92%, specificity=35%), abnormal CXR (p-value <0.0001, sensitivity=94%, specificity=37%) and hyperinflation (p-value <0.0001, sensitivity=95%, specificity=31%) were found to be independent statistically significant factors in FBA. Multivariate analysis showed a PPV of 97% when the aspiration event was witnessed along with abnormal physical and radiological findings. Conclusion: It was observed that assessment of clinico-radiological parameters is valuable in predicting FBA. The indications of RB in SFBA can be safely based on these clinico-radiological parameters.

A Five-Year Review on Pediatric Foreign Body Aspiration.

Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.

Novel Criteria System in Triaging Pediatric Foreign Body Aspiration: Chest Diseases Hospital Criteria

Objectives:Adaption of new referral criteria system for suspected pediatrics with foreign body aspiration.Methods: Bronchoscopy reports of all patients referred to Thoracic and foregut surgery unit with suspicion of foreign body aspiration from all Kuwait hospitals during the period from July 2016 to December 2017. Excluded patients who underwent bronchoscopy procedure for diagnostic purposes. Chest diseases Hospital criteria were assigned according to present initially in the emergency room, and the assigned results were blinded from the referring physician.Results:The patients were referred to our care with suspicious of foreign body aspiration from secondary hospitals in Kuwait, totaling 232 patients. Male were 149 patients and females were 83 patients, compromising 64% and 36% respectively. The mean age of the patients was 36.25 months. In general, 143 patients were negative study, and 89 patients were positive. Patients with CDH criteria was less than 3, 80.3% were negative, while CDH criteria from 3 to 6 the positive results were 76.1%, and when the CDH criteria were higher than 6, the positive results were 100%.

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration.

Objectives:Delayed diagnosis and treatment of tracheobronchial foreign body aspiration (FBA) in children may lead to morbidity and mortality. Our objective was to evaluate the anesthetic management, peri- and post-operative complications, and predisposing factors for postoperative intensive care unit (ICU) admission in children undergoing rigid bronchoscopy due to tracheobronchial FBA.Methods:This retrospective study included 81 children who underwent rigid bronchoscopy between January 2010 to July 2018 at Inonu University, Department of Pediatric Surgery, Turkey. Data regarding demographic characteristics, anesthetic management, length of ICU and hospital stays, and peri- and post-operative complications were retrieved from the hospital database.Results:The patients included 54 (66.7%) boys and 27 (33.3%) girls with a mean age of 29.6 ± 31.2 months. The most common presenting symptom was the suspicion of FBA, followed by acute-onset cough, cyanosis, wheezing and respiratory distress. Mean duration of anesthesia was 44.40 ± 14.72 min. Of the 81 patients, 18 (22.2%) were transferred to ICU and 63 (77.8%) patients were transferred to the ward postoperatively. Of the patients transferred to the ICU, 5 of them required mechanical ventilation. Some peri and postoperative complications, desaturation (n=16; 19.7%; p=0.001), mucosal bleeding (n=6; 7.4%; p=0.02), laryngeal edema (n=11; 13.6%; p<0.001), laryngospasm (n=13; 16.3%; p<0.001), were affected the frequency of intensive care transfer.Conclusion:Bronchoscopy with general anesthesia remains the golden standard for the management of tracheobronchial FBA. In such patients, a combination consisting of a detailed preoperative clinical evaluation of the patient, selection of short-acting anesthetic agents with minimal side effects for the induction and maintenance of anesthesia, and the administration of controlled ventilation can be recommended. Additionally, early diagnosis of peri- and post-operative complications, prediction of postoperative ICU requirement, and a close cooperation of anesthesiologists and surgeons are highly important.

Respiratory Morbidity Following Foreign Body Aspiration Among South Indian Children: A Descriptive Study.

AimOur work aimed to study the clinical features and radiological signs of foreign body aspiration in South Indian children.Materials and methodsWe conducted this prospective cross-sectional study for one year in the Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India in 56 cases. Our study included children younger than 14 years attending our hospital with a history of foreign body aspiration with or without respiratory distress, suspected cases of foreign body aspiration showing evidence of unilateral hyperinflation with or without evidence of collapse of the opposite lungs on chest X-ray (posterior-anterior view), and unexplained cough associated with X-ray evidence of unilateral hyperinflation or bronchiectasis. Emergency and elective rigid bronchoscopy were performed as per the clinical scenario, and patients were discharged from the hospital after stabilization. They were asked to return for two-week, three-month, and six-month follow-up evaluations.ResultsThe most common age group of patients with foreign body aspiration was six to 18 months old. A definite history of foreign body aspiration was obtained in only 32 patients (57%). Most patients (n = 22; 68.75%) presented to the hospital within one to seven days of the foreign body aspiration. Respiratory distress was the most common clinical feature, present in 96% of our patients. The most common radiographic feature in our study was obstructive emphysema, seen in 33 patients (58.9%). Foreign bodies were retrieved from 40 patients (71.4%), and no foreign body could be found via bronchoscopy in 16 patients. The most common foreign body was groundnut (n = 27; 67.5%). Only four patients had inorganic foreign bodies. The most common site of aspirated foreign bodies was the right main bronchus (n = 14; 35%). Only two patients (3.57%) had persistent pneumonia that cleared up radiologically after three months and was culture negative for bacteria.ConclusionsStrong clinical suspicion of foreign body aspiration based on history and early bronchoscopy can reduce the morbidity and mortality due to foreign body aspiration in children.

Rigid bronchoscopy for foreign body removal: an overview

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Foreign body aspiration is a potentially life threatening medical scenario. Immediate diagnosis and intervention can save the many adverse outcomes. The aim of our study was to determine the pattern, presentation and management of foreign body aspiration in our population. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a retrospective study carried out in the Department of ENT and Head and Neck Surgery And Surgical Oncology, Karnataka Institute of Medical Sciences, Hubballi comprising of 22 patients with foreign body aspiration admitted to our department from July 2015 to February 2017.All patients with high suspicion of foreign body aspiration were included in our study. All patients underwent rigid bronchoscopy under general anesthesia. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study, majority of our patients were in the paediatric age group below the age of three years. History was always accidental inhalation of the foreign body. Areca nut was the most common foreign body removed. All patients who underwent successful foreign body removal following rigid bronchoscopy completely recovered from their ailments. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;It could be concluded that rigid bronchoscopy is treatment of choice in management of foreign body aspiration especially in pediatric population. The gold standard for the diagnosis and management of this condition is rigid bronchoscopy under general anaesthesia.&lt;/span&gt;&lt;/p&gt;

Pediatric airway foreign body

Foreign body aspiration in the pediatric population is a potentially life-threatening emergency that carries both diagnostic and management challenges. Children often present after a witnessed aspiration or choking event. For those children who are asymptomatic or have nonspecific findings, clinical symptoms, chest radiography and a thorough physical examination are critical for diagnosis. A reasonable suspicion of foreign body aspiration warrants a bronchoscopy. This article focuses on the management of pediatric airway foreign bodies, including the initial evaluation, preparation, and treatment approach.

Infant with a foreign body bronchus

Foreign body aspiration (FBA) is a common cause of respiratory compromise in early childhood. Numerous unique foreign bodies in the tracheobronchial tree have been reported in the literature. FBA can result in a spectrum of presentations ranging from incidental to acutely life threatening. Described here is a case of inhalation of a live fish caught from a household aquarium by a 10-month-old infant. The infant presented to us with worsening respiratory distress, and an emergency diagnostic rigid bronchoscopy retrieved the fish and the baby survived. This instance highlights the importance of actively investigating pediatric patients with bronchoscopy when suspicion of FBA is high. This case report of a live fish aspiration in an infant that was successfully removed is a first of its kind. Keywords : bronchoscopy, foreign body aspiration, respiratory distress

ABSTRACT 815

Background and aims: Foreign Body (FB) aspiration is an common emergency condition in children below 2 years.Delay in diagnosis may cause increasing morbidity and mortality with acute and chronic pulmonary conditions.we report our experience in children with suspected foreign body aspiration. Aims: Clinical profile of children who underwent bronchoscopy for suspected foreign body. Methods: All children with clinical suspicion of foreign body aspiration, who underwent bronchoscopy from emergency room or paediatric wards during a period of 4 years (2007 to 2011) were analysed by reviewing the charts. Results: Out of the 140 children who had suspected foreign body aspiration and underwent rigid bronchoscopy by paediatric surgeons, 105 (75%) retrieved FB. Majority of the children were below two years (121, 86%). 97 (69%) were boys. History of choking and foreign body were obtained in 40% and 15% respectively.Majority of aspirated material were organic in nature (81%) which included Peanut (60,57%), Custard apple seeds (10,9.5%), Arecanut (4,3%). The inorganic material (16, 15%) found were Screw, Pencap, LED bulb and Hairpin. CXR in ER was normal in 51 (36%), of these 28 (20%) had FB.The Xray findings noted were obstructive emphysema 34 (24%) unilateral collapse 13 (9.2%) and FB was visible in 10 (7.1%) children. 55 (52%) children had FB in Right bronchus, 39 (37%) in left bronchus.Foreign body was seen in Trachea and both bronchus in 7 (7.6%), 3 (2%) children respectively.The average stay in hospital was 2.9 days.One child died before retrival of FB and two children developed tracheal tear as complication. Conclusions: Age group and the common object aspirated (Peanuts) reflects the local cultural feeding habits. Strong clinical suspicion is mandatory as significant percentage (20%) of children with FB has normal CXR.

Aspiración de cuerpo extraño durante la consulta dental en pediatría. Reporte de un caso

Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. This study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax x-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient’s safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient’s life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.

Hidden foreign body in an unexplained asthma

Foreign body aspiration (FBA) is a common condition with potential to cause significant morbidity and mortality. In children, highest incidence is within the first 3 years of life. Without witnessed aspiration or acute symptoms such as choking, coughing or respiratory distress, it may go unnoticed as clinical presentation and radiological investigations generally have low diagnostic value. Delay in diagnosis increases the risk of developing severe complications. Unexplained recurring or persistent lung pathologies in this age group should raise suspicion of FBA, and early bronchoscopy is warranted for confirmation of diagnosis. We report a case of FBA in a 2-year-old boy whom had been symptomatic for 3 months and was treated as bronchial asthma prior to diagnosis of foreign body in the left bronchus. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12017 Bangladesh J Otorhinolaryngol 2012; 18(2): 200-202

Bronchoscopie pour inhalation de corps étrangers chez l’enfant : à propos de 223cas

Inhalation of foreign body in children is a serious accident that may compromise the vital prognosis of the child. The diagnostic was difficult in the absence of a recognizable penetration syndrome. Bronchoscopy is still recommended as the appropriate diagnostic and treatment of foreign bodies. The purpose of this study was to analyze the diagnostic and the treatment result of bronchoscopy and discuss its indications.[corrected] A retrospective study analyzing data related to 223 children undergoing bronchoscopy due to suspicion of foreign body aspiration over a period of 10 years (2000-2009). The average age of the children was 29 months (range: one month-13 years). Approximately, two thirds of these patients were boys. The penetration syndrome was reported in 79.8% of cases.During bronchoscopy, the foreign body was confirmed only in 57.4%. Foreign bodies were found in the bronchus in 79.7% of cases. Among the foreign bodies, 78.1% were of vegetal origin. The average time of stay of the foreign body was of 16.1 days. Penetration syndrome and abnormal physical exam were the most sensitive parameters (79.7% and 82.8%, respectively) but with low specificity (24.2% and 35.8%, respectively). The combination of clinical and radiological signs suggestive of foreign body was the most specific sign (74.7%). Similarly, we found a statistically significant correlation between positive bronchoscopy and simultaneous suggestive clinical and radiological signs (P=0.03). The multivariate study showed that predictors factors of positivity of the bronchoscopy were: abnormal physical exam (P=0.016), abnormal radiological exam (P=0.003) and type of indication (P=0.005).The diagnosis of laryngotracheobronchial foreign body recures an array of arguments. It is suspected on the clinical interview specially penetration syndrome and on the clinical and radiological presentation. Any suspicion should lead to a bronchoscopy.

Bronchoscopic Foreign Body Extraction in a Pulmonary Medicine Department

Foreign body (FB) removal in our hospital was almost exclusively performed by surgeons through a rigid bronchoscope until the pulmonologists started getting involved in FB extraction. This study aimed to retrospectively review the results of 2 years of experience with 120 patients who presented or were referred to the Pulmonary Medicine Department, Ain Shams University Hospital in Cairo, Egypt, with clinical suspicion of FB aspiration during the period between December 2006 and December 2008. FBs were removed by either rigid and/or flexible bronchoscopy using either general or topical anesthesia. There were 54 male and 66 female patients with an age range between 3 months and 70 years and 68.5% of the patients were under the age of 10 years. Ninety patients (75%) presented with a definite history of FB aspiration, with a time interval between aspiration and presentation ranging between less than 6 hours and 12 months. The FB was visible on the chest x-ray in 42 cases. Aspirations were primarily into the right lung (53.2%). Seeds and scarf pins were the most common FB found, and were retrieved in 36 cases. Pulmonologists were successful in extracting 110 out of 111 (99.1%) bronchoscopically visualized FBs, and open thoracotomy was required in only 1 case for FB removal. In another 6 cases, only mucous plug was found to be the endogenous FB, whereas no FB could be found in 3 cases. No mortality or serious complications took place during or after the bronchoscopy. In conclusion, pulmonologists can extract FBs easily and safely either by using rigid and/or flexible bronchoscopes if they have the appropriate experience.

Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho

Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30% of such patients. Tomography-generated virtual bronchoscopy (VB) can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory symptoms and history of cough or choking with foods before these symptoms. Both patients were submitted to VB. In both cases, we detected an endobronchial foreign body, which was then removed by conventional rigid bronchoscopy in one of the cases. Only recently developed, VB is a noninvasive imaging method that has potential for use in detecting foreign bodies in the airways of children. In select cases, VB can indicate the exact location of the foreign body and even preclude the need to submit patients to rigid bronchoscopy in the absence of a foreign body.