Foreign body aspiration in children: The value of diagnostic criteria

Kıyan, Gürsu; Gocmen, Basar; Tuğtepe, Halil; Karakoç, Fazilet; Dağlı, Elif; Dağlı, Tolga E.

doi:10.1016/j.ijporl.2009.03.021

Cited by 83 publications

(82 citation statements)

References 31 publications

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“…Six patients (15%) required rigid bronchoscopy. Of those, 2 presented with tracheal FB aspiration (broken of choking has been reported in approximately 90% of the confirmed cases of FB aspiration in children, (15) whereas, in our series, a history of choking was found in 21 patients (52.5%).…”

Section: Methodscontrasting

confidence: 59%

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

et al. 2012

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Objective: To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. Methods: This was a retrospective study of all adult patients (over 18 years of age) with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. Results:The study sample comprised 40 adult patients, with a mean age of 52 years (range, 18-88 years). The median time of permanence of the foreign body in the airway was 15 days (range, 12 h to 10 years). All of the patients first underwent diagnostic flexible bronchoscopy. Foreign bodies were successfully removed with flexible bronchoscopy in 33 (82.5%) of the patients. In 1 patient, a metal object lodged in the distal bronchial tree required the use of fluoroscopy. Six patients (15%) required rigid bronchoscopy due to tracheal foreign bodyinduced dyspnea, in 2, and because the foreign body was too large for the flexible forceps, in 4. Bronchoscopy failed in 1 patient, who therefore required surgical bronchotomy. Conclusions: Although rigid bronchoscopy is considered the gold standard for the removal of foreign bodies from the airways, our experience showed that flexible bronchoscopy can be safely and effectively used in the diagnosis and treatment of stable adult patients.Keywords: Bronchoscopy; Foreign bodies; Airway obstruction; Airway management. ResumoObjetivo: Determinar a taxa de sucesso da broncoscopia flexível como primeira opção na remoção de corpos estranhos das vias aéreas em adultos. Métodos: Estudo retrospectivo de todos os pacientes adultos (acima de 18 anos) com aspiração de corpo estranho submetidos à broncoscopia no Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, em São Paulo (SP). Resultados: A amostra foi constituída por 40 pacientes adultos, com média de idade de 52 anos (variação: 18-88 anos). A mediana do tempo de permanência do corpo estranho na via aérea foi de 15 dias (variação: 12 h a 10 anos). Todos os pacientes foram submetidos primeiramente a broncoscopia flexível diagnóstica. A retirada do corpo estranho por meio de broncoscopia flexível foi bem-sucedida em 33 dos pacientes (82,5%). Em 1 paciente, um objeto metálico alojado na árvore brônquica distal requereu o uso de fluoroscopia. Seis pacientes (15%) foram submetidos à broncoscopia rígida devido a dispneia induzida por corpo estranho traqueal, em 2, e porque o corpo estranho era muito grande para as pinças flexíveis, em 4. A broncoscopia falhou em apenas 1 paciente, que portanto necessitou de broncotomia cirúrgica. Conclusões: Embora a broncoscopia rígida seja considerada o padrão ouro na remoção de corpos estranhos na via aérea, nossa experiência mostrou que a broncoscopia flexível pode ser utilizada segura e eficientemente no diagnóstico e tratamento de pacientes adultos estáveis.Descritores: Broncoscopia; Corpos estranhos; Obstrução das vias respiratórias; Manuse...

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Section: Methodscontrasting

confidence: 59%

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

et al. 2012

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“…In our survey, the sensitivity of the other radiological signs, focal hyperinflation and atelectasis, equalled 33% and 15%, respectively, while other authors reported 63.8% and 8.0%, respectively [20]. The specificity of all radiological signs listed in Table 2 was high and the sensitivity was quite low, which was confirmed by other studies [5,6]. In some centres, computed tomography is undertaken to confirm (or exclude) the presence of a FB [5].…”

Section: Discussionsupporting

confidence: 81%

“…The percentage of removed FBs (68%) was comparable with some studies [6,7], but other researchers noted lower or higher rates (57.0%, 59.1%, and 91.3%) [2,8,9]. During bronchoscopy, objects were found most often in the right main stem bronchus followed by the left, as in most surveys [7][8][9][10][11][12][13][14][15][16]].…”

Section: Discussionsupporting

confidence: 80%

Diagnosis of paediatric airway foreign body: is it easy?

Rybojad¹,

Niedzielska

Rudnicka–Drożak

2014

Open Medicine

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AbstractForeign-body aspiration in children results in diagnostic problems, mainly because of nonspecific signs. Therefore, in this study, we placed particular stress on false-positive and -negative predictors. Charts of 139 consecutive paediatric patients aged 6.0 months to 15.5 years who underwent bronchoscopy for a suspected foreign body aspiration were analysed retrospectively. A foreign body was found in 95 cases (68%). The anamnesis was positive in 91%. Cough was the most common clinical symptom (91%) with a sensitivity and specificity of 94% and 23%, respectively. There were no significant correlations between clinical symptoms and the locations of foreign bodies. The majority of focal hyperinflation (24%) and atelectasis (15%) were seen in chest radiographs, with a sensitivity and specificity of 33% and 89% (hyperinflation) and 15% and 82% (atelectasis), respectively. Chest X-rays were normal in 46 cases; however, an object was removed in 25. Persistent infiltrates were present in 14 X-rays, and a foreign body was extracted during bronchoscopy in 4. A highly significant correlation between the type of foreign body and radiological signs was noted (p = 0.00001). Anamnesis, clinical symptoms, and radiological findings are helpful in confirming aspiration, but can be misleading. Chronic or recurrent pneumonia should prompt further bronchoscopic diagnosis.

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“…The most common form of aspirated material is food [5][6][7][8][9]. Rigid bronchoscopy is recommended for children with FB aspiration impression [10,11]. Radiopaque FB aspiration, with a prevalence of 7-27 % of FB aspiration, can leave a variety of complications if not diagnosed and treated properly.…”

Section: Introductionmentioning

confidence: 99%

25-Year Review of the Abundance and Diversity of Radiopaque Airway Foreign Bodies in Children

Saki

Nikakhlagh

Heshmati

2014

Indian J Otolaryngol Head Neck Surg

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This study was conducted to review the abundance and diversity of radiopaque foreign bodies over a 25-year period. Overall records of 1,114 patients who underwent rigid bronchoscopy due to foreign body aspiration in the tertiary centres, Imam Khomeini and Apadana; over a 25-year period (1989-2014) were reviewed. History, clinical findings, plain radiography and bronchoscopic findings, foreign body (FB) aspiration (whether radiolucent or radiopaque), time from onset of symptoms until hospitalization, and delay time were all considered. The male/female ratio was 1.53. Most patients were aged 1-3 years (53.94 %). The most common location of foreign bodies was the right main bronchus (54.57 %). The most common type of radiopaque foreign body was meat, chicken and big fish bones (4.84 %) followed by metal objects (4.39 %). Coughing (70.82 %) and cyanosis (22.80 %) were the most common symptoms. The most common radiological findings were emphysema (32.31 %). Given that the radiological findings are highly specific as regards the detection of radiopaque FB, radiographic examination prior to bronchoscopy for FB localization and shortening the time of bronchoscopy in patients with a history of radiopaque FB aspiration can be helpful. Due to the high morbidity and mortality caused by prolong and repeated bronchoscopy, the use of newer techniques and equipment in shortening extraction time of the foreign bodies should be considered in future researches.

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Foreign body aspiration in children: The value of diagnostic criteria

Cited by 83 publications

References 31 publications

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

Diagnosis of paediatric airway foreign body: is it easy?

25-Year Review of the Abundance and Diversity of Radiopaque Airway Foreign Bodies in Children

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