Tracheobronchial Foreign Body Aspiration Research Articles

A rare case of tracheobronchial foreign body aspiration in an adult patient admitted to the ICU: A case report and review of the literature

Abstract We report an exceedingly rare case of a foreign body (FB) discovered in the tracheobronchial tree of an adult male admitted to the intensive care unit (ICU). The patient was admitted in a state of deep coma after sustaining injuries in a road traffic accident. The head, neck and chest CT scans revealed a foreign body lodged within his tracheobronchial tree. Emergency fibre optic bronchoscopy was performed using a size 8 endotracheal tube. Multiple pieces of glass were then removed by fibre optic bronchoscope using a stone retrieval basket. This case report highlights the importance of thorough clinical and radiological evaluation of polytrauma patients. A rigid bronchoscope is the recommended treatment modality for tracheobronchial foreign body removal, followed by a flexible fibre optic scope.

Tracheobronchial Foreign Bodies Aspirations in Adults: A 25-Years Experience

Objective:The incidence of tracheobronchial aspirations of foreign bodies in adults is lower than in children. In this article, we aimed to present our experience in tracheobronchial aspiration of foreign bodies in adults during 25-years.Methods:From January 1990 to January 2015, 122 patients older than 16 years with suspected tracheobronchial aspiration of foreign body were included in this study. Patients’ data cards were retrospectively assessed according to age, gender, clinical symptoms and physical examination findings, localization and type of foreign body, radiologic findings and therapeutic options.Results:Ninety-six of the patients were female (78.7%) and 26 were male (21.3%). The age range was 17-70 years and mean age was 30.3 years. Rigid bronchoscopy was performed in all patients. Foreign bodies were seen in 112 patients (91.8%). Foreign bodies were extracted by rigid bronchoscopy in 109 patients. Thoracotomy and pneumotomy were performed in the remaining 3 patients. The most common foreign body was pin (83%). The chief symptom was cough (100%). The most common anatomic location of foreign bodies was right bronchial system (60.7%). The main radiologic finding was radiopaque image of the related foreign body (88.4%). Right lower lobectomy was performed in two patients because of bronchiectasis.Conclusion:If tracheobronchial aspirations of foreign bodies are not treated in early period, irreversible and suppurative lung diseases may occur as results of aspirations in later years. The education of societies about this subject is principal precaution in reducing the frequency of tracheobronchial aspirations of foreign bodies.

Risk factors for preoperative respiratory complications in children with tracheobronchial foreign bodies.

ObjectiveTo identify risk factors for preoperative respiratory complications associated with tracheobronchial foreign body aspiration (TFBA) by retrospectively analysing paediatric cases presenting with or without complications.MethodsPaediatric patients who presented with TFBA and were admitted to hospital were enrolled in the study. Patients were divided into two groups based on occurrence of preoperative respiratory complications as confirmed by computed tomography. Age, sex, TFBA symptoms, type of foreign body, retention timeand location of the foreign body were documented and compared between the groups.ResultsIn total, 223 children were included: group A (n = 161) included those with respiratory complications; group B (n = 62) included those without respiratory complications. Univariate and multivariate analyses found that type of foreign body, and symptoms differed significantly between the two groups.ConclusionRespiratory complications of TFBA in children were correlated with the type of foreign body and symptoms.

Complications of tracheobronchial foreign bodies.

Tracheobronchial foreign bodies may cause several complications in the respiratory system. We aimed to present the complications of tracheobronchial foreign bodies. Between January 1990 and March 2015, 813 patients with suspected tracheobronchial foreign body aspiration were hospitalized in our department. Patients with complications related to foreign bodies in airways were included in this study. We retrospectively evaluated the records of patients according to symptoms, foreign body type, localizations, and complications. A foreign body was found in 701 of 813 patients (86.2%). Complications related to foreign bodies settled in airways were seen in 96 patients (13.7%). The most common complications were atelectasis and pneumonia in 36 (5.1%) and 26 (3.7%) patients, respectively. Other complications were bronchiectasis (n = 12, 1.7%), cardiopulmonary arrest (n = 11, 1.6%), bronchostenosis (n = 3, 0.4%), death (n = 2, 0.3%), migration of foreign body (n = 2, 0.3%), pneumomediastinum (n = 2, 0.3%), tracheal perforation (n = 1, 0.15%), pneumothorax (n = 1, 0.15%), and hemoptysis (n = 1, 0.15%). Coughing (n = 74, 77.1%) and diminished respiratory sounds (59.3%, n = 57) were the most common findings. Careful evaluation and rapid intervention are life-saving methods in tracheobronchial foreign body aspirations.

Incidental intraoperative diagnosis of retained foreign body lung misdiagnosed as pulmonary tuberculosis.

Tracheobronchial foreign body aspiration (FBA) is a very common and lethal problem among children. It can easily be diagnosed with a typical history of choking crisis. Clinical examination and radiology play a secondary role in diagnosis. Acute choking episode may lead to death or else to serious sequels such as bronchiectasis, atelectasis, and recurrent pneumonia. Here, we report an interesting case of bronchiectasis in a young female initially thought to be a consequence of pulmonary tuberculosis, who was subsequently found to have retained foreign body in the left lower lobe lung which was the actual cause of her symptoms.

Foreign Body Aspiration from Tracheostomy Inlet

Tracheobronchial foreign body aspiration is an important life-threatening clinical condition that requires emergency intervention. Compared with children, foreign body aspiration is rare in adults and sometimes could be fatal. The most common symptom is severe coughing that appears after choking. Foreign body aspiration should be considered in the diagnosis of patients with wheezing, chronic cough, voice alteration, hoarseness, or recurrent pulmonary infections. A 78-year-old male patient with tracheostomy due to laryngeal cancer was admitted to the emergency department on account of aspiration of tweezers after coughing when he was cleaning the tracheostomy cannula. The patient complained of shortness of breath and coughing. Physical examination revealed decreased breath sounds on the right side of the lung, and he had dyspnea and central cyanosis. There was a foreign body extending from the carina to the right main bronchus on the posteroanterior radiograph of the lung. In the operating room, rigid bronchoscopy was performed from the tracheostomy stoma and the foreign body was removed using forceps. This case shows that patients with tracheostomy and their relatives must be well educated in the care of stoma. Rigid bronchoscopy by an experienced specialist for foreign body aspiration is a safe and effective method for diagnosis and treatment. (Eurasian J Emerg Med 2015; 14: 142-4)

A time series observation of Chinese children undergoing rigid bronchoscopy for an inhaled foreign body: 3,149 cases in 1991-2010.

Background:In China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.Methods:This was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.Results:During the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.Conclusions:The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.

Headscarf Pin Localized in the Right Main Bronchus and Two Pins in the Abdomen

Tracheobronchial foreign body aspiration is a serious condition that might result in mortality and it necessitates emergency intervention. Studies in literature report cases of pin aspiration related to headscarf use in Muslim countries. The most frequent symptom in foreign body aspirations is coughing. Radio-opaque foreign bodies can be detected through lung radiology. Following diagnosis, the foreign body needs to be removed as soon as possible. The removal procedure is carried out by flexible fiberoptic bronchoscopy or rigid bronchoscope. We hereby present the case of a patient who presented to the emergency department with headscarf pin aspiration and whose radiography results revealed 2 pins in the abdomen and one pin in the right main bronchus.

An Unusual Case of Tracheobronchial Foreign Body Aspiration in a Laryngectomized Patient: Rolled Tissue

Abstract Tracheobronchial foreign body aspirations are the most common cause of acute respiratory obstruction and vital health problem that have to be diagnosed and managed immediately. Aspiration can lead to serious consequences up to respiratory arrest, if complete or near complete airway obstruction occurs or intervention is delayed. The existence of tracheal stoma after previous surgeries is an important factor that facilitates foreign body aspiration. In this article we present a case with total laryngectomy who aspirated roll of tissue when he tried to clean tracheal stoma. It is very important to keep in mind the possibility of foreign body aspiration through stoma in tracheotomized patients presented with respiratory compromise. Immediate diagnosis and proper intervention of this situation is life-saving. Keywords: Tracheal stoma, foreign body, aspiration

Tracheobronchial Metallic Foreign Body Aspiration in an African Child during Magic Game

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Tracheobronchial Metallic Foreign Body Spontaneous Inhalation in a Child during Magic Game

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Tracheobronchial Foreign Bodies in Children: Imaging Assessment

Tracheobronchial foreign-body aspiration is a relatively frequent pediatric emergency and a cause of substantial morbidity and mortality especially in preschool children. Although foreign-body aspiration may cause sudden airway obstruction and subsequent death, quite often symptoms are mild and nonspecific; therefore, the correct diagnosis may be delayed particularly in the pediatric population. A delay in diagnosis increases the rate of complications and can cause substantial morbidity. Early and accurate diagnosis combined with intervention through foreign-body retrieval is critical for proper patient management. For evaluation of both radiopaque and non-radiopaque airway foreign bodies in pediatric patients, imaging plays an important role in initial detection and follow-up evaluation. In this article, we discuss the currently available imaging modalities and techniques for evaluating tracheobronchial foreign bodies in infants and children. Imaging findings of various tracheobronchial foreign bodies and mimics of foreign bodies are also discussed. In addition, information regarding management of tracheobronchial foreign-body aspiration is included.

A retrospective study of anesthesia during rigid bronchoscopy for airway foreign body removal in children: propofol and sevoflurane with spontaneous ventilation

Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. We analyzed our experience in management of aspirated foreign bodies, including methods of anesthesia used, over a 4-year period. We retrospectively reviewed the records of tracheobronchial foreign body removal by rigid bronchoscopy with spontaneous ventilation in 435 children. All patients had received initial anesthesia with inhaled sevoflurane. One hundred and ninety-seven patients (Group PropRemi) then received intravenous propofol and remifentanyl for maintenance of anesthesia; the remaining 238 patients (Group PropSevo) received propofol and sevoflurane. Tracheobronchial foreign body was found in 405 children (93.1%) and successfully removed from 402 (99.3%) children. Among three patients who failed bronchoscopy, one child suffered cardiac arrest and died during the bronchoscopy, and two required subsequent tracheotomy for foreign body removal. Adverse effects (intraoperative coughing, breath holding, body movement, bronchospasm, and laryngospasm) were significantly more frequent in Group PropRemi than in Group PropSevo. No complications such as bleeding, pneumothorax, pneumomediastinum, or the need for thoracotomy were encountered. Sevoflurane induction followed by a combination of sevoflurane and continuous infusion of propofol resulted in fewer adverse events than sevoflurane induction followed by TIVA with propofol and remifentanyl during rigid bronchoscopy for airway foreign body removal in children with spontaneous ventilation.

Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients? age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge.

Foreign body aspiration (FBA) is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis. This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient's characteristics, history, clinical, radiographic, bronchoscopic findings, reason for delay presentation, and complications were noted. A total of 158 children admitted to the hospital with suspected FBA were included in this study. The average age was 3.28 years. Forty-eight (30.3%) children were presented late (more than 14 days after FBA) and 110 (69.7%) children were presented early (0-14 days). The common clinical manifestations of FBA were persistent cough (100%) and choking (72%). The most frequent radiological finding observed was air trapping (40%) followed by atelectasis (14%). Chest radiographs were normal in 32.2% patients. Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%). Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts accounted for 80% of the aspiration. FBA is difficult to diagnose in children. Delay in diagnosis appears to result from a failure to give serious consideration to the diagnosis. Early diagnosis and removal of foreign bodies must be achieved to avoid complications.

A foreign body which caused esophageal perforation and was aspirated into the right main bronchus

Tracheobronchial and esophageal foreign body aspirations are life-threatening, and require immediate intervention. Major symptoms in case of a foreign body aspiration are shortness of breath, cough, wheezing and cyanosis. In esophageal foreign bodies, the major symptoms caused by irritation are dysphagia, hypersalivation and odynophagia. Foreign bodies lodged in the cervical esophagus and hypopharynx can cause airway obstructions by moving into the adjacent organs with the effect of coughing, swallowing or esophageal peristalsis. In this study, a patient who swallowed a chicken bone which caused a perforation in the proximal esophagus and then aspirated the bone into the right main bronchus is presented. J. Exp. Clin. Med., 2014; 31:193-195

Tracheobronchial Foreign Body Aspiration in Children

Tracheobronchial Foreign Body Aspiration in Children

Delayed diagnosis and treatment of foreign body aspiration in China: The roles played by physician inexperience and lack of bronchoscopy facilities at local treatment centers

ObjectiveWe examined if lack of on-site bronchoscopy facilities and the inexperience of initial treating physicians contributed to missed or delayed diagnosis of tracheobronchial foreign body aspiration (FBA) in pediatric patients presenting with respiratory distress. MethodsThe medical records of 340 patients examined by bronchoscopy in our otolaryngology department from January 2009 to August 2012 were reviewed. Age, gender, clinical history, findings on physical examination, facilities at the initial treatment site (bronchoscopy or not), bronchoscopic findings (type and location of the FB), and initial diagnosis, were examined in terms of the delay between initial treatment and bronchoscopy-based diagnosis of FBA. ResultsThe vast majority of patients (324/340, 95.29%) were 3 years of age or younger and a foreign body was located in 309 (90.88%). Of these 340 cases, 261 had been referred from other facilities (76.76%) whereas 79 had come directly to our hospital (23.24%). The median delay between initial treatment and bronchoscopic diagnosis was significantly shorter in those treated initially in our institution compared to referrals (24h [1h to 60 days] vs. 168h [1h to 366 days]; P<0.01). The initial diagnosis was FBA in 135/261 referral cases (51.72%), significantly lower than in cases first treated in our institution (69/79, 87.34%; P<0.01). Foreign body aspiration was confirmed in 127/135 referral cases (94.07%) and 62/69 directly treated cases (89.86%) (χ2=1.193, P>0.05). Of the 126 referral cases diagnosed with other conditions before coming to our hospital, FBA was confirmed in 114. Complications were significantly less frequent in cases treated directly than in referrals (24/79, 30.38% vs. 155/261, 59.39%; P<0.01). ConclusionsLocal treatment facilities, most lacking bronchoscopy facilities and physicians who were trained to recognize FBA, misdiagnosed at least 44% of patients with respiratory distress and this led to significant delays in treatment. Greater regional access to bronchoscopy and improved training of primary care physicians will enhance diagnostic accuracy and reduce treatment delays.

A forgotten oat head aspiration in an adult patient.

Non-resolving or slowly resolving pneumonia in adults represents a diagnostic challenge for chest physicians. We present an interesting case with a forgotten foreign body as a rare cause of slowly resolving pneumonia. A 47-year-old woman was admitted for right-sided chest pain of three months’ duration. The patient had chronic cough for years, and was misdiagnosed as suffering from chronic bronchitis and asthma. She did not have a mental disease, neuromuscular disorders or use of sedative and hypnotic drugs. Chest computed tomography scan showed a tumor-like lesion (Figure 1), and a secondary lesion due to pneumonia or atelectasis. A foreign body was removed during diagnostic examination with a fibreoptic bronchoscope under local anesthesia (Figure 2). There was also granulation tissue at the posterior wall of the right lower lobe bronchus (Figure 3). Morphological examination of the foreign body was consistent with oat head. The patient reported that she had been farming oats 20 years ago. Figure 1 A chest-CT scan showing a smooth ovoid lesion in the right lower lobe Figure 2 Foreign body after removal Figure 3 Endoscopic aspect of foreign body and a mass suggestive of granulation tissue on the mucosa Occult tracheobronchial foreign body aspirations are infrequently seen in adults. It may be undetected for months to years [1], as in our case. In some cases with delayed diagnosis, pneumonitis [1] and granulation tissue appear surrounding the foreign body [2]. The oat head had probably been aspirated 20 years ago in our patient. Clinical and radiological features were consistent with pneumonitis and granulation tissue. The aspiration of a grass inflorescence can cause two different clinical pictures: obstructive type characterized by recurrent pneumonia and bronchiectasis; and migratory type, presenting with pleural or mediastinal complications [3]. An oat head moves unidirectionally, and it is impossible to expectorate once aspirated because of the nature of the structure. Although 5 cases of oat head aspiration have been reported in childhood [4], only 2 case reports [5, 6] in the adult population have been presented in the literature.

Clinical Picture, Radiological Findings, and Physical Examination in Tracheobronchial Foreign Body Aspiration: Which One is More Important?

Tracheobronchial foreign body aspiration is more frequent in children between 6 months-3 years of age, whereas it is seen less often in adults. The diagnosis of TBFB aspiration can be delayed in the adult population due to the lack of clinical suspicion. A case of a 56-year-old male patient admitted to the emergency department with a history of aspiration of a piece of carrot 4 hours previously, a cough and stridorous breathing is presented. His physical examination revealed reduced respiratory sounds in the lower zone of the left lung. There was no radiological clue of a tracheobronchial foreign body. Thus, we performed rigid bronchoscopy and found that the left lower lobe basal segment bronchus was almost totally obstructed by a foreign body (carrot) of 1.5x1 cm, which was removed. This was based on the clinical suspicion derived from the history and the physical examination alone. We emphasise that history and physical examination are more important in the diagnosis of organic or non-opaque tracheobronchial foreign body aspiration.