Tracheobronchial Foreign Body Research Articles

Comparative Review of Tracheobronchial Foreign Bodies in the Pediatric Age Group in the Kingdom of Saudi Arabia

Comparative Review of Tracheobronchial Foreign Bodies in the Pediatric Age Group in the Kingdom of Saudi Arabia

Clinical analysis of special types of tracheobronchial foreign bodies in children.

To explore the clinical diagnosis and treatment of special types of tracheobronchial foreign bodies in children and provide a reference for clinicians to formulate treatment plans. Clinical data of 29 children with special types of tracheobronchial foreign bodies who were treated at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between June 2017 and June 2022 were collected and analyzed, and their diagnosis and treatment processes were reviewed. All 29 special types of foreign bodies were successfully removed using rigid bronchoscopy under general anesthesia, with no surgical complications. For the treatment of special types of tracheobronchial foreign bodies, clinicians should make detailed surgical plans and select appropriate instruments according to different conditions to improve the surgical success rate and reduce the occurrence of complications.

Foreign Bodies in Pediatric Otorhinolaryngology: A Review.

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.

Flexible bronchoscopy for foreign body aspiration in children: A single-centre experience.

The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes. Currently, there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration. To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview. This was a single-centre retrospective study. Twenty-four patients were enrolled between January 2017 and January 2023. Medical records of patients aged below 18 years who were admitted to authors' affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital's database to Microsoft Excel 2019. Data were analysed using MedCalc Statistical Software. Patient ages varied from 9 months to 11 years. The median age was 23.5 months, 95% confidence interval (CI) 19.49-44.77. We observed age clustering in children with foreign body aspiration at our institution with three age subgroups: (1) 0-25 months; (2) 40-60 months; and (3) 120-140 months. We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together (odds ratio = 10.0, 95%CI: 1.44-29.26, P = 0.0197). Successful foreign body extraction was performed in all cases. Conversion to a rigid bronchoscope was not required in any of the cases. No major complications (massive bleeding, tracheobronchial tree perforation, or asphyxia) were observed. Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

Bilateral internal laryngeal nerve block and lignocaine nebulisation after tracheobronchial foreign body removal to prevent airway spasm in a child-A case study.

Bilateral internal laryngeal nerve block and lignocaine nebulisation after tracheobronchial foreign body removal to prevent airway spasm in a child-A case study.

Tracheobronchial Foreign Body in Children with an Insidious Medical History.

This study explored the clinical features of tracheobronchial foreign bodies (TFB) in children lacking both a foreign body aspiration history and bronchial cut-off signs on imaging. This study was conducted between 2011 and 2021, including 45 children without a choking history or tracheal interruption on CT scans. Common symptoms were cough and wheezing (91.1%, 41 cases), followed by decreased breath sounds (55.6%, 25 cases), rales (48.9%, 22 cases), and wheezing (42.2%, 19 cases). Prior to TFB confirmation, bronchopneumonia was the prevalent diagnosis (88.9%, 40 cases). Vegetable matter was the most frequent foreign body type (75.6%, 34 cases), primarily located in the right main bronchus (31.1%) and left lower lobe bronchus (22.2%). TFB in children with obscure medical histories presents non-specifically, highlighting bronchoscopy's pivotal role in diagnosis and treatment. Key Words: Bronchoscope, Paediatrics, Tracheobronchial foreign body, Diagnosis.

An Intrabronchial Foreign Body Revealed by Bronchiectasis (Bone Fragment)

Tracheobronchial foreign bodies (FB) by inhalation accidental are serious incidents and particularly common in children. In adults, they are less frequent, very often unrecognized and therefore diagnostic often difficult. Passed unnoticed or neglected, these intrabronchial FBs are responsible for repeated respiratory infections, bronchectasis, which can lead to destruction of the pulmonary parenchyma. We report a case of a neglected foreign body (bone fragment) present in the bronchus of an adult for 53 years revealed by bronchopulmonary suppurations causing bronchiectasis and treated surgically.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

An Unusual Case Report of a Foreign Body (Fish Bone) in the Trachea.

Tracheobronchial foreign body aspiration is a rare yet potentially life-threatening occurrence in adults, presenting with symptoms ranging from acute asphyxiation to coughing, breathlessness, or choking. These symptoms can be inconsistent and mimic chronic lung conditions like asthma or chronic obstructive pulmonary disease. Chest X-rays and computed tomography scans are valuable for diagnosing and locating the foreign body. However, bronchoscopy is the primary method for diagnosis and management. This case study describes a unique incident involving a fish bone lodged in the mid-trachea, emphasizing the critical importance of timely recognition and intervention.

Unusual Tracheobronchial Foreign Bodies: Clinical Presentation and Management in Adults

Unusual Tracheobronchial Foreign Bodies: Clinical Presentation and Management in Adults

Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series

We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.

Tracheobronchial foreign body aspiration in children in Soweto, South Africa: A retrospective descriptive study.

Airway foreign bodies are a common cause of accidental death in children. Tracheobronchial foreign body aspiration (FBA) can result in severe immediate and long-term complications if the foreign body is not identified and removed. Little is known about the burden of tracheobronchial FBA in the Soweto area, south of Johannesburg, South Africa. Objectives. To describe the burden and clinical characteristics of tracheobronchial FBA in hospitalised children in a tertiary-level hospital in Johannesburg. This was a retrospective, single-centre, descriptive study of children aged <10 years who presented to Chris Hani Baragwanath Academic Hospital from 1 January 2011 to 31 December 2020. Children with FBA were identified from the paediatric pulmonology and paediatric surgery databases using the relevant International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), codes (T17.4 and T17.5). Clinical and radiological data were extracted from medical records and the databases. Forty-seven children with FBA were identified during the study period. Overall, the incidence of FBA among children aged <10 years of age was 1.42 per 100 000 person-years (95.0% confidence interval 1.04 - 1.88). FBA occurred more commonly in males (66.0%; n=31), and the mean (standard deviation) age at presentation was 68 (28.2) months. Most of the children (42.6%) were in the 7 - <10-year age group, followed by the 5 - <7-year age group (27.7%). Chronic respiratory symptoms were reported in one-third of the children, and a history of witnessed FBA was reported in only 59.6% of cases. Inorganic foreign bodies (n=29; 61.7%) were aspirated more commonly than organic foreign bodies; these included metal objects such as pins or springs (21.3%), toy parts (17.0%), pen or pencil lids/stoppers (12.8%) and plastic objects (6.4%). Our study highlights the fact that tracheobronchial FBA is prevalent in school-aged children, and public safety campaigns targeted at this age group are warranted. Furthermore, to prevent sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy. What the study adds. Our study demonstrated that tracheobronchial foreign body aspiration (FBA) was most prevalent in school-aged children (7 - <10 years of age), which is in contrast to studies that have reported a high prevalence in children aged <3 years. Chronic respiratory symptoms were reported in only a third of the children, and a history of witnessed FBA was reported in only 59.6%. Chest radiographs were normal in a high proportion of cases in which a chest radiograph was done (56.3%). Inorganic foreign bodies were aspirated more commonly than organic foreign bodies.Implications of the findings. Public safety campaigns should be targeted at school-aged children in Soweto, South Africa. Clinicians should investigate children with respiratory symptoms suggestive of FBA, even if a history is not forthcoming. Furthermore, to prevent long-term respiratory sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.

Unusual Intra-Bronchial Foreign Body: About a Case Report

Tracheobronchial foreign bodies Inhalation is a frequent reason for consultation in pediatrics, but rarely seen in adults. We report the case of a 40-year-old woman, without any particular pathological history, presented for a blood- streaked purulent sputum, right subclavicular tingling chest pain and dyspnea on exertion among two days following accidental inhalation of a turkey bone. The clinical examination and the chest X-ray were normal, the chest CT scan showed a calcifield foreign body in the right lower lobar bronchus. Flexible bronchoscopy allowed an extraction of the turkey bone without complications, which was located in the initial part of the intermediate bronchus. The evolution was marked by a complete recovery. Foreign body inhalation is a real emergency and its management must be fast, based on delicate extraction by endoscopy to avoid complications.

Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France.

Tracheobronchial foreign body aspiration is a classic pediatric emergency, and its associated morbidity particularly depends on the anesthetic management, which differs according to the center and the practitioner. The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. A survey was sent via email to the member physicians of the Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The survey included 28 questions about the organizational and anesthetic management of an evolving clinical case. A total of 151 physicians responded to the survey. Only 13.2% of the respondents reported that their institution had a management protocol, and 21.7% required a computerized tomography scan before the procedure was performed for children who were asymptomatic or mildly symptomatic during the night. There were 56.3% of the respondents who reported that extraction with a rigid bronchoscope is the only procedure usually performed in their institution. Regarding rigid bronchoscopy, 47.0% used combined intravenous-inhalation anesthesia. The objective was to maintain the child on spontaneous ventilation for 63.6% of the respondents, but anesthesia management differed according to the physician's experience. Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.

Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy.

To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.

A RETROSPECTIVE STUDY ON EVOLVING TRENDS IN LOWER AIRWAY FOREIGN BODIES IN INDIAN CHILDREN AT A TERTIARY CARE HOSPITAL

Introduction Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions.[ ] The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff . Lack of proper health education, superstitions, negligence from parents side and lack of availability of timely and expert medical help results in delayed or inadequate management. . A foreign body aspiration into the respiratory tract is a serious condition of the respiratory [2 ] system, characterised by a variability of medical history, symptoms and prognosis. Methodology This study was a retrospective conducted from Jan 2018 to Dec 2022.We selected a series of 50 patients under the age of 5 yrs conducted in the Department of ENT of M.G.M Medical College and M.Y.Hospital Indore(MP). Discussion In our study highest incidence of FB was seen in the children between the age group of 1-3years which is more common because toddlers of this age group are prone to put anything coming in their hands in mouth as they explore the world. This is clearly evident in our study that the incidence of FB is more in rural areas. Tracheobronchial metallic foreign bodies early detection and removal is necessary to avoid life threatening respiratory complication. Foreign body aspiration is Conclusion a common but largely preventable problem and every case of a respiratory distress should be suspected for foreign body. Rigid Bronchoscopy is the gold standard for the diagnosis and the most safe treatment method for foreign body removal. Use of optical forceps is advantages not only for foreign body removal but also for educational, teaching, learning, record keeping &amp; medicolegal purpose also.

Correlative Factors for Types of Tracheobronchial Foreign Bodies Encountered in Children.

To characterize the correlative factors for types of tracheobronchial foreign bodies (TFBs) encountered in children. All included patients diagnosed with TFB underwent rigid bronchoscopy as the first surgery in the Children's Hospital of Chongqing Medical University. The data of 1026 patients aged 0-18years were retrospectively collected between February 2019 and January 2022. About 94.44% of the children with TFB had organic FBs, among which, peanuts were the most common FBs, followed by melon seeds and walnuts. The most common inorganic FBs included pen points or caps, plastic toys, and plastic papers. As compared to the children with organic FBs, those with inorganic FBs consisted of a higher proportion of children aged ≥3years old, a time before surgery of >7days, dyspnea, FBs size of >10mm, longer operation time, more than two operation procedures, and atelectasis. On the other hand, the proportion of children with aspiration history, cough, and obstructive emphysema in the inorganic FB group was lower as compared to the organic FBs (P< .05). The related factors related to the patient's characteristics, symptoms, operation situations, and preoperative complications can be predicted based on the identification of FB type.

Tracheobronchial Foreign Body Inhalation

Background: Foreign body aspiration (FBA) is not an uncommon entity in the population. Objectives: In the current study, we discuss our experience in the management of 234 case series with tracheobronchial foreign body removal using bronchoscopy. Materials and Methods: The bronchoscopy database (from 2021 to 2022) was reviewed for subjects with a history of FBA managed with bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. Results: A total of 234 bronchoscopies were carried out for FBA throughout the study period. FBA was more prevalent in children under the age of two (29%) and in patients over the age of ten (24%). In 205 patients, a foreign corpse was found (87.6%). The majority of organic foreign bodies were sunflower seeds (22.4%). Nonetheless, the metallic pins (25.3%) were the most frequent foreign body. The preferred location for the impaction was the right major bronchus (45.9%). Just 90.2% of these individuals had a foreign body. History had an 89.7% sensitivity and a 31% specificity for detecting FBA. Laryngeal edema, which afflicted 32 patients (13.7%), and recurrent chronic chest infection, which affected 13 patients (5.5%), were the most frequent bronchoscopy-related side effects. Conclusions: Foreign body inhalation most frequently impacted children aged 1–2 years. The history is a major element in the diagnosis, and bronchoscopy findings were strongly correlated with the patient’s history of the incident. The most frequent clinical symptom among individuals who had a proven foreign body but no history of inhalation was protracted pneumonia. The location of the most frequent foreign body lodgment in the tracheobronchial tree depends on the type of foreign body, with metallic pins occurring more commonly in the left main bronchus. Laryngeal edema, which occurred in 13.7% of bronchoscopy patients, was the most frequent complication.

Foreign Body Aspiration in Children and Emergency Rigid Bronchoscopy: A Retrospective Observational Study.

Foreign body aspiration is potentially life-threatening in paediatric age group. Early recognition and emergency intervention by Rigid bronchoscopy is life-saving. To highlight various difficulties in emergency paediatric bronchoscopy and discuss our experience in 138 patients. < 12years children with suspected foreign body aspiration were included. Data of 138 patients < 12years of age were studied. The most common foreign body found was peanut and organic foreign bodies constituted of total foreign bodies removed. Choking, Cough and sudden onset breathlessness were common symptoms. Tachypnoea, asymmetric breath sound, rhonchi, stridor, reduced chest movements were common signs. Obstructive emphysema was commonest radiological findings. Majority of the patients were discharged within 72h & only two patients expired. History, clinical and radiological findings are highly indicative of foreign body in the airway. Inspite of being a high risk procedure, Rigid bronchoscopy when performed with necessary expertise,trained anaesthesia team and a paediatric ICU, saves majority of lives of children with tracheobronchial foreign bodies.

Çocuk Yaş Grubu Yabancı Cisim Aspirasyonu Tedavisinde Kullanılan Rijit Bronkoskopi Esnasında Uygulanan İki Anestezi Tekniğine Cerrahi Bir Bakış

Objective: In our study, we aimed to reveal the advantages and disadvantages of inhalation and intravenous anesthesia techniques in the maintenance of anesthesia in pediatric patients whose tracheobronchial foreign body was removed by rigid bronchoscopy under general anesthesia, from both anaesthesia and surgical perspectives, different from the literature.&#x0D; Methods: The patients were divided into two groups, each consisting of 34 individuals, whose anaesthesia was maintained with sevoflurane inhalation or propofol infusion. Demographic characteristics of the patients, symptoms at presentation, radiological examinations, anaesthesia and surgical procedures, complications were analyzed. In addition, surgical difficulty and surgical comfort scales created from the experiences of our institution were used. The results obtained and the effects of inhalation and intravenous anaesthetics used in maintenance on the duration of the procedure, clinical, hemodynamic and surgical comfort were compared.&#x0D; Results: Vital signs during the procedure were similar in both groups. was similar. The duration of bronchoscopy was statistically significantly shorter in the intravenous anaesthesia group (p=0.014), and secondarily, the duration of anaesthesia was significantly longer in the inhalation anaesthesia group (p=0.027). While the surgical difficulty scale was similar in both groups, the surgical confort scale was significantly higher in the intravenous anesthesia group (p=0.017). Intraoperative, postoperative complications were similar in both groups.&#x0D; Conclusion: Anaesthesia maintenance with sevoflurane prolongs the duration of bronchoscopy and accordingly the duration of anaesthesia, and also reduces surgical satisfaction independent of processing time. For these reasons, we think that while rigid bronchoscopy is performed for the removal of childhood foreign body aspirations, propofol can be preferred for anaesthesia maintenance, resulting in a shorter procedure time and higher surgical satisfaction.