Tracheobronchial Foreign Body Research Articles

Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

<p class="abstract"><strong>Background:</strong> The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.</p><p class="abstract"><strong>Methods:</strong> The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied. </p><p class="abstract"><strong>Results:</strong> The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.</p><p><strong>Conclusions:</strong> History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies. </p>

Characteristics of correct diagnosis versus misdiagnosis of paediatric tracheobronchial foreign body.

PurposeTo characterize and compare children with correct diagnosis (CD) and misdiagnosis (MD) of tracheobronchial foreign body (TBFB).MethodsA retrospective study was performed to review the medical records of children with CD group and MD group of TBFB. CD was defined when TBFB was identified during the first hospital visit. Otherwise, MD was considered. Demographic information, including gender, age, and clinical information, including clinical presentations and characteristics of foreign bodies, were retrieved. These characteristics were compared between two groups by Student’s t-test or Wilcoxon two-sample test, or Chi-square analysis or Fisher’s exact test, when appropriate.ResultsA total of 462 children with final diagnosis of TBFB were identified, with 276 children having CD and 186 children having MD. The most common location to identify the TBFB was right main bronchus in both CD and MD groups. Children with the previous history of respiratory tract foreign body were more likely to receive the CD. Children in MD group were more likely to have fever, as well as wheezing and crackles during physical examination. They were more likely to have pneumonia. Most common TBFB were peanuts. The majority of the TBFB were removed by the flexible bronchoscope coupled with forceps.ConclusionCareful history taking and physical examination, especially for those children with unclear causes for their pneumonia or asthma, or children with no improvement on the treatments, should be performed to rule out the possibility of TBFB. Bronchoscopy should be performed if necessary.

SUCCESSFUL REMOVAL OF A DENTAL CROWN WITH CRYOTHERAPY AND RIGID BRONCHOSCOPY

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Aspiration of foreign bodies occurs most frequently in extremes of age, and these bodies are commonly lodged in the segment of the right middle lobe.1 Foreign body aspiration in adults is associated with such risk factors as alcoholism, drug abuse, mental retardation, and neuromuscular conditions. The most common foreign bodies aspirated are food and broken fragments of teeth.1,2 Foreign body aspiration can cause such complications as atelectasis, obstructive pneumonitis, bronchial stenosis, and endobronchial actinomycosis.3 CASE PRESENTATION: Our patient is a 47yo M with a known history of epilepsy who presented after his primary care physician found a foreign body on chest x-ray (CXR). One year prior to presentation he had a seizure and a dental crown was dislodged from his front tooth. He immediately experienced wheezing, and minor shortness of breath, but this resolved within days. Nine months later he began to have chest pain, worse in the mornings and with inspiration, moderate in severity, and associated with cough and fever. He was treated with multiple rounds of antibiotics as an outpatient for presumed bronchitis. CXR revealed what was believed to be his crown and a right upper lobe post-obstructive pneumonia. He underwent flexible bronchoscopy, which noted complete occlusion of the entrance of the right upper lobe with granulation tissue surrounding the crown. In order to facilitate the removal of the foreign body, rigid bronchoscopy was used. Forceps failed to grasp the crown, and it was successfully removed with the cryoprobe. During the retrieval the crown was dislodged and moved to the right lower lobe where it was finally removed from the patient. He was noted to have purulent drainage coming from the right upper lobe after removal of the foreign body. He did present to the emergency room three days later for pneumonia and acute hypoxemic respiratory failure. CXR noted diffuse interstitial infiltration and he was admitted for treatment. DISCUSSION: Cryoadhesion has been an effective means of removing foreign bodies, and this modality has been successful with various objects. The cryoprobe has been shown to be most useful with objects that have a high water content given to its ability to obtain sub-zero temperatures in a matter of seconds. CONCLUSIONS: Rigid bronchoscopy has benefit over flexible for centrally located foreign bodies, large amount of granulation tissue, or objects that require manipulation. Complications from rigid bronchoscopy include pneumothorax, bleeding, and hypoxia. Patient selection and the skill level of the operator are crucial in preventing adverse outcomes.2 Reference #1: Oke V., Vadde R., Munigikar P., et al. Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital. Journal of Community Hospital Internal Medicine Perspectives. 2015;5(5):28589. Reference #2: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: Presentation and management in children and adults. Chest. 1999;115:1357–62. Reference #3: Folch E, Mehta AC. Foreign body aspiration and flexible bronchoscopy. In: Flexible Bronchoscopy. 3rd edition: Wang KP, , Mehta AC, Turner JF. Chichester, Wiley-Blackwell. 2012, pp 238–49. DISCLOSURES: No relevant relationships by Benjamin Batson, source=Web Response No relevant relationships by Ximena Solis, source=Web Response No relevant relationships by Andres Yepes, source=Web Response

Flexible Bronchoscopic Removal of Foreign Bodies from Airway of Children: Single Center Experience Over 12 Years

To report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode. Hospital records of tracheobronchial foreign body extractions between January, 2006 and January, 2018 were reviewed. Clinical presentations, radiological findings, location and types of tracheobronchial foreign bodies, types of bronchoscopes, complications and outcome of the procedures were analyzed. 283 extractions in children with median (range) age of 18 (5-168) months were reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps, was successful in 260 cases. No major complications were encountered. Mean (SD) time for the procedure was 31 (6.3) minutes. Airway foreign bodies can safely be removed by flexible bronchoscopy with minimal complications. This procedure can be considered the primary mode for removal of airway foreign bodies by a trained and experienced person.

Foreign body aspiration – still a challenge in pediatrics?

Tracheobronchial foreign body aspiration in children represents a diagnostic and therapeutic emergency in the practice of pediatricians and ENT specialists. Delaying the diagnostic and, implicitly, the bronchoscopic extraction of the foreign body can lead to complications, some even with vital prognosis. In this paper, the authors present from their personal experience two pediatric cases of tracheobronchial foreign bodies diagnosed and treated at different time intervals after the moment of aspiration.

Tracheobronchial Foreign Body Aspiration in Childhood

Tracheobronchial Foreign Body Aspiration in Childhood

Anesthetic Management of Tracheobronchial Foreign Body Aspiration Cases in Children

Anesthetic Management of Tracheobronchial Foreign Body Aspiration Cases in Children

Tracheobronchial Foreign Bodies: The Importance of Timely Intervention and Appropriate Collaboration.

The aim of study is to determine epidemiological profile of the cases suspected to have laryngotracheobronchial foreign body, average interval between onsets of symptoms and presentation to our tertiary centre, average interval between admission and active surgical intervention, incidence of various clinical, radiological and intraoperative findings. All patients presenting to our institution with suspicion of foreign body inhalation who underwent rigid bronchoscopy from October 2012 to April 2018 were considered for this study. Data compilation of these patients was done which included age, sex, chief complain, time of onset, time of presentation to hospital, time till intervention was undertaken, clinical and radiological findings, nature of foreign body, history of ingestion, intraoperative findings and post-operative recovery. All these aspects were then evaluated. Our study included 89 cases who underwent rigid bronchoscopy under General Anaesthesia. 67.4% were male and 71% were children less than 2years of age. 36% presented within the first 48h and 64% of these were managed within 24h of presentation. Of these 50.6% gave history of foreign body inhalation and cough was the most common presentation in 92.1%. Collapse was the most common radiological finding in 42.7% cases. Lodgement of foreign body was slightly more on right side (45.5%). Most of the foreign bodies were of vegetative nature-84.7%. There was no mortality out of all 89 cases. Although the mortality and complication rate has decreased significantly after the advent of endoscopically assisted bronchoscopy, still attention needs to be given to earlier diagnosis of foreign body aspiration and earlier referral to an ENT surgeon for bronchoscopy if required. Also the time duration between intervention to be undertaken from the time of symptom onset can be decreased with a better collaboration between the Radiologist, the Paediatrician and the Otorhinolaryngologist.

Tracheobronchial foreign body in an extremely preterm infant complicated with pulmonary hemorrhage

Tracheobronchial foreign bodies in preterm neonates are extremely rare. They are usually iatrogenic and associated with dislodgement of medical devices. The narrow airways of neonates pose a challenge in removal of foreign bodies. The obstructing object or attempt of removal in itself may cause significant morbidity or mortality. We report a rare case of pulmonary hemorrhage secondary to a tracheobronchial foreign body in an extremely preterm infant and its successful removal. Literature reviews show atelectasis, pneumonia, and respiratory distress being the most common complications from a tracheobronchial foreign body. Removal of tracheobronchial foreign bodies in the narrow airways of neonates can be a grueling task with multiple risks. A high index of suspicion is needed for early detection of foreign body in the airways to avoid morbid complications.

Foreign body aspirations in children: A retrospective analysis in a tertiary care paediatric hospital

Foreign body aspirations in children: A retrospective analysis in a tertiary care paediatric hospital - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2019.0007, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

ROLE OF HRCT THORAX IN TRACHEOBRONCHIAL FOREIGN BODY DETECTION

Background: Aspirated foreign bodies in the airway continue to present challenges to the otorhinolaryngologist and interventional pulmonologists. To established the role of HRCT in diagnosis of foreign bodies in suspected cases.
 Methods-30 patients with suspected FB inhalation on the basis of clinical history and symptoms like respiratory distress, stridor, and history of chocking were recruited for study in department of Otorhinolaryngology in Sardar Patel Medical College and Hospital, Bikaner Rajasthan.
 Results: 29 patients (96.67%) with foreign bodies were identified on chest CT. For the patients with tracheobronchial foreign bodies, the occurrence of unilateral hyperlucent lung and post-obstructive lobar or segmental infiltrates on plain chest X-ray was 43.33%. 17 patients (56.67%) had no abnormalities on plain X-ray. The difference between multidetector CT and plain X-ray results was statistically significant.
 Conclusion: Foreign bodies are missed byclinical and X-ray examination in many cases and that is only picked up by HRCT. Thus it is the ideal modality in diagnosis of foreign bodies to avoid the morbidity and mortality associated with missing foreign body.
 Keywords: foreign bodies, high resolution computed tomography, X-ray

Risk factors for lower respiratory tract infection in children with tracheobronchial foreign body aspiration.

The aim of this study was to determine the risk factors for lower respiratory tract infection (LRTI) in children caused by tracheobronchial foreign body aspiration (TFBA).A total of 351 patients were retrospectively reviewed; all patients were diagnosed with TFBA at West China Hospital of Sichuan University from 2015 to 2017. Univariate analyses and multivariate analysis were used.Age (<2 years) (P < .001), type of foreign body (plant) (P < .001), shape of foreign body (nonsmooth) (P < .001), and residence time of foreign body (>7 days) (P = .001) were risk factors for LRTI on univariate analysis. Multivariate analysis showed age (<2 years) (hazard ratio [HR] = 4.457; 95% confidence interval [CI] = 2.031–6.884; P < .001), type of foreign body (plant) (HR = 2.686; 95% CI = 1.577–3.452; P < .001), shape of foreign body (nonsmooth) (HR = 1.649; 95% CI = 1.437–3.663; P < .008), and residence time of foreign body (>7 days) (HR = 1.751; 95% CI = 1.329–3.554; P = .004) were independent risk factors for LRTI. Furthermore, children with LRTI also had longer lengths of hospital stays and antibiotic use than did children without LRTI.Age, plant foreign body, nonsmooth foreign body, and long-term incarceration were all independent risk factors for LRTI in children. These results can help us to select more appropriate intervention times and stratified treatment for children with TFBA.

Aspirated teeth - rigid or flexible bronchoscopy

Tracheobronchial foreign bodies are a common problem in clinical practice. We present the case of a patient with three aspirated teeth following a motor vehicle accident.

Anaesthetic management in tracheobronchial foreign body aspiration: A retrospective analysis

Anaesthetic management in tracheobronchial foreign body aspiration: A retrospective analysis

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.

Management of Tracheobronchial Foreign Bodies in Adults and Children: 117 Cases

Management of Tracheobronchial Foreign Bodies in Adults and Children: 117 Cases

A single-center experience of pediatric foreign-body aspiration: A retrospective 4-year case series.

Introduction:Foreign body aspirations (FBA) in children are serious life-threatening clinical conditions that require immediate intervention. In this study, it was aimed to retrospectively investigate the demographic features, clinical diagnosis and treatment methods of children admitted to our clinic due to FBA.Materials and Methods:The study included 86 children aged <16 years, diagnosed with tracheobronchial foreign body aspiration (FBA) between January 2013 and December 2017. All patients with two-way chest radiography were examined for foreign body aspiration diagnosis. In case of suspicion of diagnosis, low-dose multi-slice chest CT was taken. In cases of FBA diagnosis, rigid bronchoscopy was performed under sevoflurane and propofol anaesthesia supported by controlled ventilation. Evaluation was made of the patient demographic characteristics, type and localization of the foreign body removed with bronchoscopy and operation-related complications.Results:The mean age of the patients with FBA diagnosis was 3.17 years and 55.8% (n = 48) of the patients were male. The most commonly aspirated foreign body was nuts (peanut and hazelnut) (70%) and the most common finding on the chest radiographs was obstructive emphysema, determined on 51% of the patients. Bronchoscopy revealed that the foreign body was in the right main bronchus and left main bronchus in 41%.Conclusion:The main treatment for FBA is prevention. However, in patients applied with bronchoscopy for FBA, controlled ventilation and appropriate general anesthesia should be generally used. Early bronchoscopic intervention with safe anesthesia and controlled ventilation support will improve the success rates in FBA cases.

The role of flexible bronchoscopy accomplished through a laryngeal mask airway in the treatment of tracheobronchial foreign bodies in children

IntroductionWe here present our experience with children who underwent flexible bronchoscopy for removal of inhaled tracheobronchial foreign bodies under general anesthesia via a laryngeal mask airway (LMA). Materials and methodsA total of 24 (16 male and 8 female, mean age: 30.75 ± 29.68 months) patients who underwent flexible bronchoscopy under general anesthesia using a LMA for suspicion of tracheobronchial foreign bodies between July 2016 and April 2018 were retrospectively reviewed. ResultsThe mean duration of admission to hospital was 162.56 ± 309.56 h. Sixteen (66.7%) patients were found to have tracheobronchial foreign bodies. All procedures were successfully accomplished through a LMA by using basket forceps, a Fogarty catheter and a suction without any need for rigid bronchoscopy. 11 (68.7%) of tracheobronchial foreign body locations were right bronchial, 3 (18.8%) were left bronchial and 2 (12.5%) were tracheal. The types of extracted tracheobronchial foreign bodies were organic in 14 (87.5%) and non-organic in 2 (12.5%). There were no complications except laryngeal edema noted in 2 (8.3%) patients, relieved within 48 h. The mean time of postoperative hospitalisation was 2.42 ± 0.97 days. ConclusionFlexible bronchoscopy accomplished through a LMA is a safe, easy and effective technique, not only as a diagnostic procedure, but also as the initial therapeutic modality for retrieving tracheobronchial foreign bodies in children with high success and low complication rates. With further reports aforementioned, we hope that the flexible bronchoscopy will become a standard method in children.

Two interesting cases of long standing non-asphyxiating intrabronchial foreign bodies

The long standing intrabronchial foreign body presents problems of diagnosis and treatment which are very different from those associated with the recently inhaled foreign body There may be no history to suggest the original incident the clinical picture is usually clouded by superadded pathological changes atelectasis pneumonitis or bronchiectasis Two such cases are presented in an attempt to find common characteristics recognition of which may assist correct diagnosis The tracheobronchial foreign bodies are best managed by rigid bronchoscopy Preventative educational strategies should be implemented to reduce such an avoidable risk

TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION: THE GREAT MIMICKER

SESSION TITLE: Signs and Symptoms of Chest Disease SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tracheobronchial foreign body (FB) aspiration is rare but it can mimic other, more common conditions. CASE PRESENTATION: A 53 y/o male with COPD presented with a chronic cough. The cough was non-productive and intermittent with no identifiable triggers. He was treated for bronchitis several times with no real improvement. He denied hemoptysis, night sweats or weight loss. CXR showed a right middle lobe infiltrate with volume loss. Chest CT revealed a large area of bronchiectasis and interstitial infiltrate in the medial right lower lung field, right hilar lymphadenopathy and a right hilar nodule measuring 2cm x2.3cm transversely, thought to represent a central malignancy. He had a 20 pack year smoking history. Physical exam was unremarkable for pulmonary abnormalities. Bronchoscopy revealed an erythematous, fungating, polypoid lesion at the orifice of the RML. What appeared to be a foreign body was seen amidst the irritated bronchial mucosa. This foreign body was removed with forceps and was later identified as a drinking straw. The surrounding bronchial mucosa was edematous and erythematous. The distal RML contained thick secretions which were suctioned and cultured. Endobronchial biopsies were performed at the area of the FB removal to ensure no malignant changes were present. The patient continued to do well post-procedure and his cough eventually resolved. DISCUSSION: Tracheobronchial FB aspiration is uncommon and only accounts for about 0.16 to 0.33% of adult bronchoscopic procedures.1 A choking episode followed by coughing and dyspnea are often described, but not always. The retained FB can then cause symptoms that mimic chronic conditions such as COPD, recurrent pneumonia1 and possible malignancy. Most episodes are seen in children, but up to 25% of cases involve adults,1 making the differential quite broad if there is a lack of acute symptoms. In adults, neurological deficits, altered mental status, impaired cough reflex and intoxication increase the risk of FB aspiration.1,2 If asymptomatic, FBs are often found incidentally on imaging. CXR will only identify FBs about 25% of the time, therefore chest CT is preferred.1 Chest CT often shows focal abnormalities such as: atelectasis, bronchiectasis, consolidation1 or findings suggestive of malignancy. Bronchoscopy with removal of the FB should be completed early after identification to prevent further lung damage. Traditionally, rigid bronchoscopy was performed, but flexible bronchoscopy is becoming more frequently used.1 CONCLUSIONS: Tracheobronchial FB aspiration is uncommon and can present as more common chronic conditions or even suggest malignancy. Our patient had a chronic cough and CT findings suggestive of malignancy. Upon bronchoscopy, the abnormality was identified as a previously aspirated FB that had likely been in place for months to years. This case illustrates a FB aspiration presenting as possible malignancy. Reference #1: Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F. “Foreign body aspiration in adult airways: therapeutic approach.” Journal of Thoracic Disease. 2017;9(9):3398-3409. https://doi.org/10.21037/jtd.2017.06.137. Reference #2: Alharthi BJ, et al. “Occult Foreign Body in the Lung Mimicking Bronchogenic Carcinoma.” Case Reports, 2014; https://doi.org/10.1136/bcr-2014-207438. DISCLOSURES: No relevant relationships by Raed Alalawi, source=Web Response No relevant relationships by Audra Schwalk, source=Web Response