Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.

Abstract

Abdulmajid, 0. A., Ebeid, A. M., Motaweh, M. M., and Kleibo, I. S. (1976). Thorax, 31,[635][636][637][638][639][640]. Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases. During the last 14 years 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to Kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. Asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after the bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery. PATIENTSOf our 250 patients, 105 were under 2 years of age (42%), 105 were aged 2-6 years (42%), and 30 were 6-10 years old (12%). Only 4% of cases were above 10 years of age. One hundred and forty patients were female (46%) and 110 were male (44%). Of the foreign bodies, 70% were located in the right bronchial tree, 17% in the trachea, and only 13% in the left bronchial tree. wheezing, cough, and dyspnoea which gave rise to a suspicion of foreign body inhalation. 3. Radiographic findings: 80% of patients showed normal radiographic findings and only 8% showed a definite foreign body shadow (Fig. 1). In eight cases the radiograph showed bilateral obstructive emphysema due to partial obstruction of the trachea, and in 12 cases it showed right or left lung emphysema due to partial obstruction of the bronchi (Fig. 2). Ten patients showed atelectasis of a lobe, of which seven were right lower lobes (Fig. 3) and three left lower lobes (Fig. 4). NATURE OF FOREIGN BODIESSeventy per cent of the foreign bodies were melon seeds and 15%1 were peanuts, shells of various nuts, and almond kernels. The rest (15%) were screws (9 cases), metal pins (6 cases), fish bones (4 cases), a rosary bead, metal clips (2 cases), an ear-ring, a pebble, a nail cutter, and a metal toy (Fig. 5).

Bronchial foreign body misdiagnosed as pulmonary tuberculosis

“…Early diagnosis of foreign body in the airway has been hinged on the tripod of a history of foreign body inhalation, clinical presentation and radiographic findings. 2 This however has some shortcomings as an acute episode of inhalation may escape the notice of the caregivers, the child may not present with the classic symptoms and because of the fact that most foreign bodies are radiolucent, the chest radiographs are frequently normal as was seen in the case presented. 6,7 Late diagnosis of foreign body has been defined as occurring beyond three days between aspiration of the foreign body, or onset of symptoms and the correct diagnosis.…”

“…1,2,3 The location of a foreign body is dependent not only on its size and shape but also on the position taken by child at the time the aspiration takes place. 4,5 In 5-60% it is located in the left bronchus while in 30-40% it is seen in the right bronchus and in the trachea in 10-15%.…”

“…7 Retained and neglected foreign bodies in the respiratory tract are fraught with a myriad of complications. Common complications of undiagnosed foreign bodies include obstructive emphysema, recurrent pneumonia, lung abscess, cystic bronchiectasis, atelectasis of a lobe, asthma, lung collapse, bronchial stenosis 2,7,8 and pneumomediastinum. 3 The index case presented with most of the outlined complications.…”

Delayed Presentation Of A Girl With A Sour Plum Seed In The Trachea

“…99% of foreign body airways were successfully treated endoscopically 11 . With careful insertion of laryngoscope, inspecting at each level of insertion before advancing the scopes to ensure the foreign body is not pushed further down by tip of laryngoscope.…”

“…Darrow (2011) reported about 20.4% patient with foreign body airway presented to hospital between first to seventh days of incidence. The most common reasons for delay in seeking treatment were asymptomatic cases, financial constraint beside an inappropriate diagnosis and treatment given in the peripheral hospital 11 .…”