Organic vs. Inorganic Tracheobronchial Airway Foreign Body Aspiration: Does Type/Duration Matter?

Abstract

Objective We sought to determine the time course of clinical and histologic differences between aspirated inorganic and organic foreign bodies. Study Design In‐vivo. Methods Twenty Sinclair miniature swine (Sus scrofa domesticus) were divided into two groups—inorganic or organic foreign bodies. Either an organic (peanut) or an inorganic (Lego) foreign body was placed within a bronchus and left for 3, 5, 7, 14 or 21 days. The airway was reassessed at the predetermined endpoint at which time endoscopic, gross, and histopathological findings were documented. Specimens were scored with a pathologic scoring system to assess injury severity from the foreign body. Results Foreign bodies were successfully placed in all 20 swine. Two animals required early euthanasia due to respiratory compromise. The foreign body was identified grossly in eight (40%) animals. An additional three (15%) had microscopic evidence suggestive of a previous foreign body of an undetermined duration. There was no difference in injury severity between organic and inorganic foreign bodies. The 3‐day group had injuries limited to the bronchial lining, whereas the longer duration groups had bronchial and adjacent lung parenchymal involvement. There was no difference in injury severity between days 5 and 21. Conclusions Airway foreign bodies initially cause bronchial damage. After 5 days, the foreign body causes lung parenchymal changes. There was no difference in airway lesion severity between organic and inorganic foreign bodies. Level of Evidence N/A Laryngoscope, 131:490–495, 2021

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

“…We also found a correlation between the retention time of TFBA and LRTI. In our study the incidence of LRTI was 46.6%, 68.6% and 68.6% respectively with the retention time of within 24 hours, one week and more than one week,which was consistent with the results of a previous animal experiment 9 . In this animal experiment, it was found that most of the TFBA could cause tracheal damage within 5 days, and pneumonia more than 5 days.…”

“…It is controversial whether there is a difference in the degree of trachea inflammation caused by the type of TFBA. Although it has been reported that the intratracheal granulation in TFBA is related to the degree of TFBA oil release 17 , no correlation was found in animal experiments 9 . As for age, we speculate that the immunity of younger children is relatively weak so that they are easier to get LRTI when encounter the same TFBA.…”

“…Studies are mainly focused on bacterial culture 7,8 . According to previous studies, there was no correlation between the type of TFBA and LRTI in animal studies, whereas the retention time of TFBA was related 9 . A research reported that type, shape and the retention time of TFBA and age were associated with LRTI 10 .…”

“…In addition, it is reported that the type of TFBA was an independent risk factor for LRTI 10 . However, recent animal experiments found that there was no difference in tracheal damage between organic and inorganic foreign bodies 9 . Similarly, we found that there was no statistical difference in the incidence of LRTI among legumes, nuts, other organisms and non-organisms.…”

Optimized Fuzzy C-Means Algorithm-Based Coronal Magnetic Resonance Imaging Scanning in Tracheal Foreign Bodies of Children

“…When diagnosing atypical foreign bodies in the trachea of infants and young children, it is necessary to use X-rays for chest plain radiographs and fluoroscopy to determine the presence of foreign bodies through indirect signs. However, when the imaging manifestations such as pulmonary obstruction, pulmonary block shadows, and atelectasis occur, it is easy to be misdiagnosed as bronchial pneumonia, bronchial lung cancer, bronchial asthma, and other diseases, and the misdiagnosis rate is high [ 5 ]. Ordinary CT axial images increase the detection rate of foreign bodies, and the display clarity of indirect lung signs is better than X-ray, but it has the disadvantages of slow scanning speed, only presenting axial images, and easy to miss small foreign bodies.…”