Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery

Abstract

The present paper describes eight patients (two teenagers and six adults) who had chronic symptoms (haemoptysis, cough, recurrent pneumonia) caused by foreign body (FB) inhalation which went undetected for 3 months to 25 yr. None of the patients had the usual predisposing conditions like mental retardation, seizures or brain tumour. The diagnosis of FB was made by radiography in one patient only. Computerized tomography visualized one FB (a beef bone), and bronchoscopy identified FB in another two patients. The remaining four cases were diagnosed at thoracotomy. Removal of FB was curative in three of five cases who required surgical resection for irreversible bronchiectatic changes. The severity of pulmonary changes correlated with duration of symptoms. It is concluded that chronic, unexplained respiratory symptoms should warrant further investigation to exclude FB despite negative history and normal chest radiography. Finding of granulation tissue or cicatricial stenosis of the bronchus could be the only clue to the presence of a FB. Early diagnosis would avoid irreversible parenchymal changes which necessitate lung resection.

Fish bone inhalation in infancy

“…Although paroxysmal cough, wheezing and decreased breath sounds are the cardinal symptoms and signs of foreign body inhalation, they are present only in a limited number of cases [13,21] and may be absent in others [4,6,19]. In extreme cases, a foreign body may remain asymptomatic for up to 25 years [2]. As the diagnosis is too often missed by clinicians, a high level of suspicion is necessary and requires a detailed history and careful physical examination.…”

Review of tracheobronchial foreign body aspiration in the South African paediatric age group

“…The longer the FB is retained, the more likely are complications (e.g., atelectasis, post-obstructive pneumonia). A FB that causes chronic or recurrent distal infection may lead to bronchiectasis (31,39,40,59,60). This complication should be treated after the FB is abstracted.…”

Removal of Tracheobronchial Foreign Bodies in Adults Using a Flexible Bronchoscope: Experience with 200 Cases in China

“…However, a history of FB aspiration might not be obvious, and the related symptoms, such as chronic cough, dyspnea and hemoptysis for most adult patients could remain unnoticed for months to years (1,2). The delayed diagnosis of FBs may lead to serious complications such as granulation formation, recurrent pneumonia, atelectasis and endobronchial stenotic scarring (3)(4)(5).…”

“…The extraction of FBs using a flexible bronchoscope is one of the most commonly used techniques (3,6,7). A few published studies have described the clinical features and endoscopic management of tracheobronchial FBs (2,3,(5)(6)(7)(8)(9)(10). However, the sample sizes of these studies were small, and few of them reported the management of the complications of FBs aspiration.…”