Tracheobronchial Foreign Body Aspiration Research Articles

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.

A Case of Migratory Foreign Body in Left Bronchus -Scarf Pin.

Tracheobronchial foreign body aspiration is a life threatening emergency which requires immediate medical attention. Foreign body aspiration caused by sharp objects like scarf pins was more common in young girls, possibly due to casual handling of sharp objects. Most of the patients were symptomatic with cough and choking episodes. The penetration and dislodgement was the most commonly reported symptom in the majority of the patients. Here we are presenting a case of a young female with accidental swallowing of sharp scarf, following which she developed throat pain and cough. A detailed radiological examination was performed which showed that a foreign body had migrated into the left bronchus, which was removed with a bronchoscope. This case demonstrates the emergency management of a sharp foreign object that was inhaled into the airway.

Anesthetic concerns during rigid bronchoscopy for the management of a friable vegetative foreign body in an infant

Tracheobronchial foreign-body (FB) aspiration is a commonly encountered entity in the pediatric population. FB aspiration (FBA) is an emergency condition requiring early recognition and management, and the primary treatment is the surgical removal of FB under anesthesia. Herein, we report a unique case of an infant developing prolonged severe respiratory distress due to obstruction following a vegetative FBA and shall also discuss the related anesthetic concerns.

Foreign Body Aspiration in Children: Review of 198 Cases from Anesthesiology Perspective

Background: Tracheobronchial foreign body aspiration is an emergency in childhood. Rigid bronchoscopy is used for diagnosis and treatment. In our retrospective study, we aimed to evaluate anesthesia man-agement, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body type and localization and length of hospitalization.Materials and Methods: The file of 198 pediatric patients who underwent rigid bronchoscopy by pediatric surgery with the diagnosis of foreign body aspiration in Harran University Medical Faculty Hospital be-tween 2016-2018 were retrospectively analyzed. All cases were managed under general anesthesia. The anesthesia management, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body and localization, length of stay were obtained from patient records and retrospectively evaluated.Results: Localization of foreign bodies were found to be 4.5% in trachea, 48% in right main bronchus and 33.9% in the left main bronchus. 25.3% of foreign bodies were seed, 25.62% were peanuts and 5.62% were organic substances such as beans, needle was removed in 7.6% cases, and toy pieces was removed in 9.6% cases respectively. Low levels of saturation, hypercarbia, arrhythmia, laryngospasm and bron-chospasm were observed as complications of anesthesia.Conclusions: Foreign body aspiration is an emergency that requires early diagnosis and urgent interven-tion. It is important to be aware of the complications that may occur during anesthesia and momentous to be intervened by an experienced team.

Risk Factors for Lower Respiratory Tract Infection Associated With Tracheobronchial Foreign Body Aspiration in Children.

Tracheobronchial foreign body aspiration (TFBA) is a major cause of accidental death in children. Lower respiratory tract infection (LRTI) may be caused by TFBA, but there are few reports about LRTI associated with TFBA. This study collected TFBA cases in our hospital to analyze LRTI and determine its risk factors. A total of 194 children who underwent tracheobronchial foreign body (TFB) extraction in The Children's Hospital of Zhejiang University School of Medicine from June 2019 to April 2020 were enrolled. CT chest is routinely used in the workup of suspected airway FB at our institution to evaluate for patients, a FB was already highly suspected. The retention time was defined as from the time of TFB inhalation or presentation (if there was no history of TFBA) to the time of TFB removal. General characteristics including weight, clinical symptoms, operative records, cervicothoracic CT, retention time, type of TFB and postoperative hospitalization time were collected. Chi-square tests, rank sum tests and multivariate logistic regression analyses were performed. The incidence of LRTI was 46.6%, 68.6%, and 68.6% when the retention time was within 24 hours, between 24 hours and up to 1 week and more than 1 week, respectively. Postoperative hospitalization time of LRTI group was significantly longer than that of non-LRTI group. Findings for cervicothoracic CT as pneumonia, emphysema, atelectasis meant more serious clinical manifestations and the retention time was longer in the LRTI group than in the non-LRTI group. There was a positive correlation between the retention time of a TFB and LRTI in multivariate logistic regression analysis. The incidence of LRTI caused by TFBA is high. LRTI is association with longer postoperative hospitalization time. The TFB retention time is an independent risk factor for LRTI. If a patient presents with significant LRTI symptoms, a course of steroids and antibiotics maybe a safer approach rather than proceeding immediately with bronchoscopic removal.

THE ROLE OF RIGID BRONCHOSCOPY IN CHILDREN WITH TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION

To assess the role of rigid bronchoscopy in children with tracheobronchial foreign body aspiration (FBA) a retrospective study was carried out in Pediatrics Ward of Bakhtawar Amin Trust Hospital & Medical & Dental College Multan for 1 year. A total of 80 children aged 6 months to 15 years with foreign body aspiration were included in the study. Data was collected from the medical histories of the patients. Rigid bronchoscopy was performed in all patients under anesthesia. All the data was analyzed by using SPSS version 21. The study was conducted on total 80 patients whose mean age was 2.5 years. 66 (82.5%) patients aspirated organic FBs, while 14 (17.5%) aspirated inorganic FBs. Cyanosis (37,46.2%) and stridor (33,41.2%) were the most common symptoms. In 78 (97.5%) patients rigid bronchoscopy was performed. In 75 (93.7%) not post operative event occurred. Medical history of patients with FBA is important for diagnosis. In addition, bronchoscopy is mandatory in patients with history of choking even if chest x-ray and initial examination are normal.

Can Clinical and Radiological Diagnosis Reduce the Need for Bronchoscopy in Pediatric Tracheobronchial Foreign Body Aspiration Cases?

ObjectivesTo assess the diagnostic accuracy and efficacy of taking history, conducting physical examination, and assessing the radiological characteristics of children suspected of having aspirated foreign bodies (FBs), vis-à-vis tracheobronchoscopy, the gold standard diagnostic tool. An additional objective was to analyze the types and locations of aspirated FBs.MethodsThis single-center retrospective cohort study used the archived medical data of consecutive pediatric patients who had presented with suspected tracheobronchial FB aspiration (TFBA) from January 2011 to May 2021. Data regarding clinical presentation, radiological impressions, and intraoperative findings were retrieved from electronic medical records.ResultsThe subjects comprised 44 children (22 male) with a mean age of 25.4 months (median = 17.5 months). The majority (27; 61.4%) had TFBA. Among the clinical symptoms, choking and coughing had a sensitivity of 93.9% and specificity of 30.0% and 50.0%, respectively in confirming the presence of a FB. Positive physical examination results had a sensitivity of 95.8% and specificity of 63.2%. Radiological results had a sensitivity of 60.0% and specificity of 78.9%. Organic substances constituted 47.7% of the aspirated FBs.ConclusionsProper clinical assessment with history, physical examination, and imaging can highly predict the presence of TFBAs in children, and help the clinician decide whether bronchoscopy is necessary.

Foreign-body aspiration into the lower airways in adults; multicenter study.

BackgroundForeign-body aspiration is common in children aged 6 months to 3 years. However, with the aging population and increasing prevalence of disabilities such as hemiparesis and neuromuscular diseases in adults, an increased incidence of aspiration is expected.MethodsThis was a multicenter retrospective, observational study in four major referral hospitals in Daegu, South Korea, between 2000 and 2019. We included patients aged over 18 years who were evaluated for tracheobronchial foreign-body aspiration by flexible bronchoscopy. Comorbidities, type and location of foreign body, and radiologic findings were recorded.ResultsOf 138 patients who underwent flexible bronchoscopy for tracheobronchial foreign body aspiration, 91 (65.9%) were men; the mean age was 66.3 (range: 29–87) years. A history of definite choking was present in 60 (43.5%) patients. The most common site of the foreign body was the right bronchus intermedius (27.5%). The most common type of aspirated foreign body was teeth (37.7%), followed by chicken bone (15.2%), nuts (14.5%) and fish bone (9.4%). Iatrogenic events accounted for 37.0% of the cases of aspiration, and the foreign body was successfully removed by flexible bronchoscopy in 91.3% of cases.ConclusionForeign-body aspiration is not rare, even in adults who do not have predisposing factors. Iatrogenic events accounted for about 40% of all cases of foreign body aspiration. In adults, flexible bronchoscopy is relatively safe and has a high success rate for foreign-body removal.

Neglected Foreign Bodies in Bronchi in Adults: Experience of 2 Cases

Tracheobronchial foreign body (FB) aspiration is a life-threatening condition that is more common in children than in adults. They are often diagnosed immediately and the foreign body is extracted as soon as possible. However, cases of neglected foreign body aspiration where it is unknown to the patients or they have forgotten the history of aspiration have been reported in the literature. The symptoms depend on the site of the FB impaction ranging from chronic mild wheezing, through to a cough, a complaint of discomfort, general shortness of breath, recurrent pneumonia, or mimicking asthma. In this article, we intend to illustrate two cases of forgotten bronchial foreign bodies that were successfully treated via the process of bronchoscopic extraction in Hanoi Medical University Hospital.

Paediatric airway and challenges during COVID

Paediatric airway brings some unique challenges to anaesthesiologist. Anaesthesiologists are at particularly high risk of being exposed to Covid cases because airway management, particularly tracheal intubation, positive pressure ventilation through a mask, and management of tracheostomy tubes, causes widespread aerosolization of the virus2.But these cases cannot be deferred. The aim of our presentation is to discuss the various challenges we faced managing these presumptive COVID positive pediatric airway cases , not only because of logistic issues but also to optimize the airway and work in a coordinated way with ENT surgeons in the common airway . We present the anaesthetic management of few challenging paediatric cases of tracheobronchial foreign body aspiration, Laryngeal web presenting with stridor, laryngeal papillomatosis during this period April 2020 to September 2021 in our institute.

Tracheobronchial Foreign Bodies Aspiration

A foreign body aspiration occurs when a foreign object becomes lodged in the airway, causing breathing difficulties or choking. Objects can enter the respiratory and digestive tracts through the mouth and nose, but when an object enters the respiratory tract, it causes aspiration. The foreign bodies can then lodge in the trachea or further down the respiratory tract, such as in a bronchus. Regardless of the type of item, any aspiration can be a life-threatening situation that demands immediate evaluation and response to reduce the risk of negative outcomes. Despite significant improvements in clinical outcomes as a result of enhanced care, there were still 2,700 fatalities. The literature on tracheobronchial foreign bodies aspiration was retrieved using the Cochrane Database of systematic reviews, Pubmed, and Google scholar. Keywords and phrases used during the search included “tracheobronchial,” “bronchial,” and “aspiration.” This review aims to reflect on the pattern of tracheobronchial tree foreign-body aspiration and the rate of success for rigid bronchoscopy in children admitted to a single center and the correlation between the type of foreign bodies and the age of the patients, presentation of the patient, and comorbidities.

A Case of Whistle as Foreign Body in Trachea

Background. Most of foreign body aspiration cases are found in children under the age of fifteen. Pediatric patients often presents with non-food foreign body aspiration, such as toys. The most common clinical manifestation are history of choking following foreign object insertion into the mouth (85%), paroxysmal cough (59%), wheezing (57%) and airway obstruction (5%).
 Case presentation. Main principle of airway foreign body extraction is to do it immediately in the most optimal condition with slightest possible trauma. Rigid bronchoscopy is a suitable choice for tracheal foreign body extraction. We reported a case of seven years old male with tracheal foreign body presented with history of whistle ingestion five hours prior to admission. This patient was discharged from hospital after third days of rigid bronchoscopy procedure.
 Conclusion. History of foreign body aspiration in children should be suspected as a tracheobronchial foreign body. Rigid bronchoscopy is preferred to extract foreign bodies present in the trachea. The prognosis for tracheobronchial foreign body aspiration is good if the foreign body is treated early and without complications.

A Tertiary Care Centre Experience on the Management of Paediatric Tracheobronchial Foreign Body During the COVID 19 Pandemic.

Tracheobronchial foreign body aspiration (FBA) is a life threatening emergency most commonly seen among paediatric age group that requires immediate therapeutic intervention. The purpose of this study is to report our experience on management of these aspirated foreign body (FB) with rigid bronchoscopy during the COVID 19 pandemic. This is a retrospective study which included 100 children less than 17 years of age, diagnosed with suspected FBA and underwent rigid bronchoscopy for its removal between March 2020 and March 2021. Guardians of all female children with history of FBA, had to go through medicolegal enquiry considering the possibility of female infanticide. Analysis of data was made of the demographic details, characteristics and location of the aspirated FB, treatment modalities and difficulties encountered. Among the 100 patients included in the study, 67% were under 3 years of age. The male to female ratio was 2.23:1. 69% of the FB’s were most frequently found in the right main bronchus. 63 cases of the removed FB were organic materials such as nuts. Tracheobronchial FB’s should be suspected in children who have sudden onset of cough and respiratory distress, even when physical and radiographic evidence is absent. Mortality due to FBA is preventable by early intervention with bronchoscopy. During the Covid 19 pandemic before performing any emergency procedure, prior preoperative planning and use of personal protective equipment is important, considering the very high risk of transmission of the virus due to aerosol generation.

A CASE OF RETAINED ORAL CARE SPONGE IN THE BRONCHUS CAUSING PNEUMONIA IN CHRONICALLY VENTILATED PATIENT

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aspiration of foreign bodies is not uncommon and mostly accidental with the highest prevalence in young children [1]. Occurrence in adults is rare and usually as a result of diminished consciousness, sedation, trauma, and neuromuscular disorders. We present a case of a 70 year old patient receiving chronic mechanical ventilation who had multiple episodes of hypoxia due to a dislodged oral care sponge. CASE PRESENTATION: A 70 year-old bedbound male with chronic mechanical ventilation (via tracheostomy?) after traumatic brain injury, and recurrent pneumonia was admitted for pneumonia. On admission, respiratory cultures grew Carbapenem resistant Acinetobacter Bumanii and Pseudomonas Aeruginosa with negative urinalysis and blood cultures. Chest radiograph showed bilateral lower lobe opacities. He was treated with vancomycin, polymyxin B, and meropenem. However, his FiO2 fluctuated between 40% and 60% and despite being on antibiotics he was persistently febrile. He continued to have copious secretions requiring frequent suctioning without any new infiltrates on repeat chest radiograph. A Computer tomography (CT) of the chest was performed which showed a tubular structure extending from the right main bronchus to the bronchus intermedius (Image 1). Bronchoscopy was done and the object was found to be the head of an oral care sponge. After foreign body removal his respiratory status improved and fevers resolved. DISCUSSION: Oral care in mechanically ventilated patients has been studied extensively and there are many guidelines recommend to minimize ventilator associated pneumonia. Extreme care must be taken by providers as defective products or aggressive technique can result in fragments being dislodged into the oral cavity and can result in aspiration especially in patients with chronic tracheostomy. In patients with tracheostomy, diminished airway protective mechanisms and a deflated balloon can result in an increased risk of foreign body aspiration. Aspiration of a foreign body is a significant cause of morbidity as it can cause asphyxiation or trauma to the airway resulting in pneumothorax, bleeding, and infections [2]. In patients with diminished consciousness the signs of foreign body aspirations can be subtle such a mild cough, fevers, frequent infections, or increasing oxygen and they may not be able to provide a proper history. CONCLUSIONS: This case highlights the need for vigilance regarding potential complications from providing oral care in the elderly who have diminished ability to protect their airway. REFERENCE #1: 1. Ding G et al., Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study. Medicine (Baltimore). 2020 May 29;99(22):e20480. REFERENCE #2: 2. Aissaoui, N. H. Salem, and A. Chadly, "Unusual foreign body aspiration as a cause of asphyxia in adults: an autopsy case report," The American Journal of Forensic Medicine and Pathology, vol. 33, no. 3, pp. 284–285, 2012. DISCLOSURES: No relevant relationships by Kabu Chawla, source=Web Response No relevant relationships by Varun tej Gonuguntla, source=Web Response Speaker/Speaker's Bureau relationship with pfizer Please note: $1001 - $5000 by Yizhak Kupfer, source=Admin input, value=Consulting fee No relevant relationships by Sharad Oli, source=Web Response No relevant relationships by kiran para, source=Web Response No relevant relationships by Ankur Sinha, source=Web Response

Predictors for intraoperative heart failure in children undergoing foreign-body removal.

This study aimed to determine the predictors for intraoperative heart failure (HF) in children undergoing foreign-body removal. The clinical data of all children with tracheobronchial foreign-body aspiration admitted to the First, Second, and Fourth Affiliated Hospitals of Harbin Medical University between January 1996 and September 2018 were analyzed. The variables with significant difference in univariate analysis were involved into the multivariate Logistic model to determine the predictors for intraoperative tachycardia. In total, 300 tracheobronchial foreign-body aspiration children were eligible for the study, among whom 60 cases (20%) suffered from HF during the operation. Between the children HF and those without HF, the differences were pronounced in history of allergy, history of asthma, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect (P < .05). Multivariate analysis results showed that history of allergy (odds ratio [OR]: 1.395, 95% confidence interval [95% CI]: 1.202–1.620, P < .001), congenital heart disease [OR: 3.071, 95% CI: 1.141–8.264, P < .001], preoperative respiratory infection [OR: 2.345, 95% CI: 1.027–5.355, P = .043], retention time of foreign bodies [OR: 1.013, 95% CI: 1.010–1.016, P < .001], duration of operation [OR: 1.030, 95% CI: 1.027–1.033, P < .001], and poor anesthesia effect [OR: 1.125, 95% CI: 1.117–1.134, P < .001] were identified as the influencing factors for intraoperative HF. In conclusions, for children undergoing foreign-body removal, history of allergy, congenital heart disease, preoperative respiratory infection, retention time of foreign bodies, duration of operation, and poor anesthesia effect are associated with an increased risk of intraoperative HF.

Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors

BackgroundTracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures.MethodsWe retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients.ResultsThe ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h.ConclusionPediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

Çocuk Hastaların Trakeobronşiyal Yabancı Cisim Aspirasyonlarında Rijit Bronkoskopi Süresince Anestezi Uygulamalarımız

Objective: Bronchoscopy is the gold standard in the diagnosis and treatment of tracheobronchial foreign body aspiration (TBFBA) in children. Rigid bronchoscopy (RB) under general anesthesia is generally preferred in children. In this article, our anesthesia experiences during rigid bronchoscopy performed for tracheobronchial foreign body aspiration and removal of foreign bodies in children are shared. Methods: The medical records of all patients aged between 0-18 years who underwent RB under general anesthesia due to suspicion of TBFBA between January 1, 2014 and December 31, 2018 were retrospectively analyzed. Results: TBFBA was more common in boys and organic foreign body aspiration was significantly higher in patients between 13-36 months of age. Patients most frequently presented with cough and wheezing. Most of them were operated between 8 am and 4 pm. TFBs were localized in the right and left main bronchi at a similar rate. Anesthesia induction was usually achieved with iv. propofol, total intravenous anesthesia and sevoflurane inhalation was administered for maintenance of anesthesia. Except for proximally located TBFBs, intermediate-or short-acting muscle relaxants were applied to most of the cases depending on the duration of the procedure. Three patients were intubated postoperatively and transferred to intensive care unit. Respiratory distress responded to medical treatment in 25 patients. No cardiac arrest or death occurred during the procedure. Conclusion: RB and anesthesia procedure for TBYCA requires experience. There is no clear recommendation about premedication, the use of muscle relaxants should be evaluated according to the localization of TBYC. In anesthesia management, intravenous or inhalation anesthetics can be used.

A Case Report on Cyanotic Spell: Suspected Foreign Body

Tracheobronchial Foreign Body Aspiration (FBA) remains a significant cause of morbidity and mortality in children less than three years of age. High index of suspicion leads to early diagnosis and treatment thus preventing further deleterious complications. This case report is about a 15-month-old female child who presented with intermittent low-grade fever, cough, cold for 20 days and rapid breathing since one day. On examination, she had pallor, grade 3 protein energy malnutrition according to Indian Academy of Paediatrics classification, heart rate was 128/min, respiratory rate was 44/min, oxygen saturation was 88% on room air with nasal flaring, intercostal and subcostal retractions. Bilateral rhonchi with reduced air entry was present in all areas of the lung. Bilateral bronchopneumonia was seen on chest X-ray and tuberculosis work up was negative. Child was started on oxygen, antibiotics, nebulisations and intravenous fluids. On day two of admission child developed rigorous bouts of cough associated with hypoxia, bradycardia, cyanosis and listlessness which improved on bag and mask ventilation. Following a strong suspicion of obstruction in the tracheobronchial tree, a Computed Tomography (CT) neck and chest was done which was suggestive of either an intratracheal or intrabronchial foreign body. Child was urgently taken up for rigid bronchoscopy and a ground nut was found in the right main bronchus. The FBA as a differential diagnosis of chronic cough in children should always be ruled out.

A Case Report on Cyanotic Spell: Suspected Foreign Body

Tracheobronchial Foreign Body Aspiration (FBA) remains a significant cause of morbidity and mortality in children less than three years of age. High index of suspicion leads to early diagnosis and treatment thus preventing further deleterious complications. This case report is about a 15-month-old female child who presented with intermittent low-grade fever, cough, cold for 20 days and rapid breathing since one day. On examination, she had pallor, grade 3 protein energy malnutrition according to Indian Academy of Paediatrics classification, heart rate was 128/min, respiratory rate was 44/min, oxygen saturation was 88% on room air with nasal flaring, intercostal and subcostal retractions. Bilateral rhonchi with reduced air entry was present in all areas of the lung. Bilateral bronchopneumonia was seen on chest X-ray and tuberculosis work up was negative. Child was started on oxygen, antibiotics, nebulisations and intravenous fluids. On day two of admission child developed rigorous bouts of cough associated with hypoxia, bradycardia, cyanosis and listlessness which improved on bag and mask ventilation. Following a strong suspicion of obstruction in the tracheobronchial tree, a Computed Tomography (CT) neck and chest was done which was suggestive of either an intratracheal or intrabronchial foreign body. Child was urgently taken up for rigid bronchoscopy and a ground nut was found in the right main bronchus. The FBA as a differential diagnosis of chronic cough in children should always be ruled out.

Clinical evaluation for bronchoscopic management in pediatric patients suspected to have foreign body inhalation.

Background: Tracheobronchial foreign body aspiration in pediatric is a life-threatening condition, the early diagnosis and treatment are crucial to prevent complications. Patients and Methods: 51 patients younger than 14 years, were studied in Al-Khanssa teaching hospital, according to their age, sex, time of presentation, history of foreign body aspiration, clinical, radiological as well as bronchoscopic findings. Results: In 51 patients (27 males, 24 females), mean age 4.3 years, largest portion presented within first 24 hour of FB aspiration (43%), positive history was noted in 84.3%, with PPV of 95.5%, NPV of 85.7%, most common clinical presentations were dyspnea (68.6%) and cough (64.7%),most common finding in clinical examination was rhonchi (47.1%), the consolidation was the most common CXR findings(35.3%), negative CXR noted in 29.4%, most commonly encountered FB is organic materials (54.9%), mainly food, Right Main Bronchus (RMB) is the most common site of FB impaction (35.3%) followed by Left Main Bronchus (LMB) (31.4%), then trachea (9.8%), Rigid Bronchoscopy (RB) was done urgently in most of the cases (78%), additional procedures are needed in limited number of cases and they included esophagoscopy and thoracotomy, no mortality or morbidity were recorded after RB. Conclusion: Positive history of inhalation is most important indicator of TFBA, clinical findings can aware doctor for possibility of TFBA especially in toddlers, however none of clinical findings are specific, the most specific Chest X-Ray finding (CXR) is detection of radiopaque FB, however this is uncommon finding, hence most common aspirated FB are organic radiolucent materials, negative CXR cannot exclude TFBA, especially when history and clinical findings are suggestive, the rigid bronchoscopy, remains the gold standard in the management of TFBA.