The causes and complications of late diagnosis of foreign body aspiration in children. Report of 210 cases

"Chronic bronchial foreign body managed by lobectomy and latissimus dorsi flap: case report"

INTRODUCTION AND IMPORTANCE

Foreign body aspiration is a common occurrence, with severe outcomes seen in all age groups. It can present like any chronic respiratory disease with a wide spectrum of misleading symptoms, resulting in misdiagnosis and delays in appropriate treatment.

CASE PRESENTATION

Here we present a case of a 11 year boy diagnosed with occult foreign body aspiration, chronically impacted in the left secondary bronchus, presented with bronchiectasis and multiple failed attempts at bronchoscopic retrieval.

CLINICAL DISCUSSION

Surgically managed by a left lower lobe lobectomy via a mini thoracotomy, reinforced with a pedicled latissimus dorsi flap. Upfront surgery will reduce the bronchoscopic morbidity incurred in repeated attempts needing pot-op ventilatory support due to edema and repeated general anaesthesia risks.

CONCLUSION

A high degree of suspicion is a key to diagnosis. There should be a low threshold for surgical management in chronic impactions.

Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children

Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042).

CONCLUSION

FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making.

WHAT IS KNOWN

• Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process.

WHAT IS NEW

• The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.

Coin Aspiration Presenting as Chronic Cough and Tracheoesophageal Fistula

Chronic cough can be a diagnostic challenge in the pediatric population. Foreign body aspiration without typical signs and symptoms can often be overlooked as a cause of chronic cough in children. Coin aspirations in the trachea typically have a sagittal orientation on an anteroposterior (AP) chest radiograph. We report a rare case of a previously healthy five-year-old girl presenting with a chronic cough for five months caused by a coin with a coronal orientation on an AP chest radiograph. The coin, initially presumed to be lodged in the esophagus, was actually lodged in the cervical trachea, leading to the development of a tracheoesophageal fistula (TEF). Her AP chest radiograph showed a coronal, circular radio-opaque shadow and the lateral view a tangential radio-opaque shadow, prompting an initial evaluation by esophagogastroduodenoscopy, which was normal. She then underwent rigid bronchoscopy, revealing a coin lodged in the trachea along with a TEF. Surgical removal was achieved through an external approach with a vertical tracheotomy and insertion of a tracheostomy tube. Five days later, a repeat rigid bronchoscopy showed a well-healed TEF, and she was successfully decannulated. She was ultimately discharged home on room air and oral feeds. TEF as a complication of a foreign body lodged in the trachea or esophagus is rare but life-threatening. Foreign body aspiration should always be considered in the differential diagnosis when evaluating younger children with chronic cough.

Risk Factors for Lower Respiratory Tract Infection Associated With Tracheobronchial Foreign Body Aspiration in Children

OBJECTIVES

Tracheobronchial foreign body aspiration (TFBA) is a major cause of accidental death in children. Lower respiratory tract infection (LRTI) may be caused by TFBA, but there are few reports about LRTI associated with TFBA. This study collected TFBA cases in our hospital to analyze LRTI and determine its risk factors.

METHODS

A total of 194 children who underwent tracheobronchial foreign body (TFB) extraction in The Children's Hospital of Zhejiang University School of Medicine from June 2019 to April 2020 were enrolled. CT chest is routinely used in the workup of suspected airway FB at our institution to evaluate for patients, a FB was already highly suspected. The retention time was defined as from the time of TFB inhalation or presentation (if there was no history of TFBA) to the time of TFB removal. General characteristics including weight, clinical symptoms, operative records, cervicothoracic CT, retention time, type of TFB and postoperative hospitalization time were collected. Chi-square tests, rank sum tests and multivariate logistic regression analyses were performed.

RESULTS

The incidence of LRTI was 46.6%, 68.6%, and 68.6% when the retention time was within 24 hours, between 24 hours and up to 1 week and more than 1 week, respectively. Postoperative hospitalization time of LRTI group was significantly longer than that of non-LRTI group. Findings for cervicothoracic CT as pneumonia, emphysema, atelectasis meant more serious clinical manifestations and the retention time was longer in the LRTI group than in the non-LRTI group. There was a positive correlation between the retention time of a TFB and LRTI in multivariate logistic regression analysis.

CONCLUSIONS

The incidence of LRTI caused by TFBA is high. LRTI is association with longer postoperative hospitalization time. The TFB retention time is an independent risk factor for LRTI. If a patient presents with significant LRTI symptoms, a course of steroids and antibiotics maybe a safer approach rather than proceeding immediately with bronchoscopic removal.

Diagnostic clues for the identification of pediatric foreign body aspirations and consideration of novel imaging techniques

OBJECTIVE

To better understand the diagnosis of foreign body aspiration by elucidating key components of its clinical presentation.

METHODS

This is a retrospective cohort study of pediatric patients with suspected foreign body aspiration. We collected information regarding demographics, history, symptoms, physical exam, imaging, and operative findings for rigid bronchoscopies. An evaluation of these findings for an association with foreign body aspiration and the overall diagnostic algorithm was performed.

RESULTS

518 pediatric patients presented with 75.2 % presenting within one day of the inciting event. Identified history findings included wheeze (OR: 5.83, p < 0.0001) and multiple encounters (OR: 5.46, p < 0.0001). Oxygen saturation was lower in patients with foreign body aspiration (97.3 %, p < 0.001). Identified physical exam findings included wheeze (OR: 7.38, p < 0.001) and asymmetric breath sounds (OR: 5.48, p < 0.0001). The sensitivity and specificity of history findings was 86.7 % and 23.1 %, physical exam was 60.8 % and 88.4 %, and chest radiographs was 45.3 % and 88.0 %. 25 CT scans were performed with a sensitivity and specificity of 100 % and 85.7 %. Combining two components of the diagnostic algorithm yielded a high sensitivity and moderate specificity; the best combination was the history and physical exam. 186 rigid bronchoscopies were performed with 65.6 % positive for foreign body aspiration.

CONCLUSION

Accurate diagnosis of foreign body aspiration requires careful history taking and examination. Low-dose CT should be included in the diagnostic algorithm. The combination of any two components of the diagnostic algorithm is the most accurate for foreign body aspiration.

Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities

OBJECTIVE

To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract.

METHODS

Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected.

RESULTS

One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p = 0.0046).

CONCLUSION

In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:1361-1366, 2023.

Delayed diagnosis of foreign body aspiration in children

AIMS

To assess the diagnostic and therapeutic difficulties as well as the long-term complications of prolonged endobronchial foreign body retention.

METHOD

Between January 2000 and May 2021, 794 patients with suspected foreign body aspiration (FBA) were hospitalized in our department. A total of 12 patients with a delayed diagnosis of over 1 month were included. FBAs were confirmed by flexible or rigid endoscopy. A retrospective analysis of medical records was performed.

RESULTS

Six male patients and six female patients were hospitalized due to prolonged FBA. The average age was 6.90 years (range: 1-13 years). The average duration of the foreign body retention was 2.60 years (2 months to 9 years). A choking event was found in eight cases. Coughing and wheezing were the main symptoms and signs. A misdiagnosis of asthma was made for five patients. Two atypical clinical presentations led to diagnosis of endobronchial foreign body, unilateral pleurisy, and hemoptysis. We report one case of an occult foreign body externalized spontaneously through a pneumo-pleuro-cutaneous fistula. The most common clinical and radiological findings were of pneumonia and atelectasis. Computed tomography showed localized bronchiectasis in three patients. FBAs were removed with a rigid bronchoscope in eight cases. Other extractions were carried out with a flexible endoscope. The foreign bodies were most frequently of vegetable origin, such as seeds and peanuts. A granulation tissue was observed in seven cases. Bronchial stenosis and bronchiectasis are the most common late complications. Only one patient needed a surgical intervention.

CONCLUSIONS

FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases, even in the absence of a previous choking event. Clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided in order to prevent complications. Open surgery may be required when lung abscess has occurred.

Case of impacted subglottic metallic foreign body removal without tracheostomy through an endotracheal tube

A foreign body in the upper airway can cause serious morbidity and mortality, especially in pediatric patients. This case report describes an innovative way to remove an impacted foreign body distal to the vocal folds through an endotracheal tube without tracheostomy.

Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child

We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation.

Clinico-Radiological Profile and Outcome of Airway Foreign Body Aspiration in Children: A Single-Center Experience From a Tertiary Care Center in Eastern India

Background Foreign body aspiration is one of the leading causes of childhood morbidity and mortality among older infants and toddler age groups. Missed and delayed diagnosis of foreign body aspiration can lead to increased incidence of complications. Early diagnosis can prevent life-threatening complications and morbidity. In this study, we aimed to evaluate the clinical and radiological details, types, localization of foreign bodies, complications, and outcomes in pediatric patients who presented to our hospital with foreign body aspiration. Methodology We conducted a retrospective analysis of hospital case records of children aged one month to 14 years who were admitted to the Department of Pediatrics between June 2018 and May 2020, with clinical suspicion of foreign body aspiration. Results A total of 22 children with a diagnosis of airway foreign body were included. The mean age of presentation was three years (SD: ±2.22), with a boy-to-girl ratio of 3.4:1. Cough (81.8%) and tachypnea (72.7%) were the most common clinical symptoms. The median duration between symptom onset and diagnosis was three (interquartile range: 6) days. Unilateral reduced breath sound (81.8%) was the most common clinical examination finding. The common site of impaction was the right main bronchus in 59.1% of cases. The foreign bodies retrieved during bronchoscopy were organic substances in 63.6% of cases, with peanuts being the most common (31.8%). Chest radiographs were normal in 36.3% of cases, and common abnormalities included hyperinflation, collapse, consolidation, and mediastinal shift. Mechanical ventilation was required in 54.5% of cases. The mean duration of hospitalization was five (SD: ±2.84) days. Complications such as pneumothorax were seen in one (4.5%) case. Mortality was seen in 4.54% of cases during the bronchoscopic procedures. Conclusions Foreign body aspiration was common in young male children, with cough being the common symptom. Normal X-rays of the chest were seen in one-third of cases. The common site of impaction was the right main bronchus, and organic substances such as peanuts were common foreign bodies retrieved. Strong clinical suspicion of foreign body aspiration should be kept in cases with acute onset of cough in young children. Prompt medical attention is needed to reduce the morbidity and mortality associated with foreign body aspiration.

Nearly missed laryngeal foreign body

Foreign body ingestion and aspiration can present as a life-threatening emergency in children. These foreign bodies are diagnosed based on history, physical exam, and focused radiography to reduce the risk of excessive radiation. We describe a case of a 3-year-old child who ingested magnetic beads and presented to the emergency department with no symptoms. On a single view x-ray of chest and abdomen, the magnetic beads were identified in the abdomen but a closer look at these single view x-rays raised a suspicion of additional foreign bodies in the larynx. A dedicated x-ray of the neck identified 2 more magnetic beads locked with each other on either side of the epiglottis. These laryngeal magnetic beads were nearly missed on initial x-rays, especially because the child had no symptoms of upper airway obstruction. This case report provides further evidence that in the evaluation of radiopaque foreign bodies in children we should strongly consider "nose to rectum" x-rays.

Clinical Prediction Models for Suspected Pediatric Foreign Body Aspiration: A Systematic Review and Meta-analysis

Importance

Although various clinical prediction models (CPMs) have been described for diagnosing pediatric foreign body aspiration (FBA), to our knowledge, there is still no consensus regarding indications for bronchoscopy, the criterion standard for identifying airway foreign bodies.

Objective

To evaluate currently available CPMs for diagnosing FBA in children.

Data Sources

Performed in Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL database with citation searching of retrieved studies.

Study Selection

Prediction model derivation and validation studies for diagnosing FBA in children were included. Exclusion criteria included adult studies; studies that included variables that were not available in routine clinical practice and outcomes for FBA were not separate or extractable.

Data Extraction and Synthesis

We followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies and the Prediction Model Risk of Bias Assessment Tool framework. Data were pooled using a random-effects model.

Main Outcomes and Measures

The primary outcome was the diagnosis of FBA as confirmed by bronchoscopy. Characteristics of CPMs and individual predictors were evaluated. The final model presentation with available measures of performance was provided by narrative synthesis. A meta-analysis of individual predictor variables and prediction models was performed.

Results

After screening 4233 articles, 7 studies (0.2%; 1577 patients) were included in the final analysis. There were 6 model derivation studies and 1 validation study. Air trapping (odds ratio [OR], 8.3; 95% CI, 4.4-15.5), unilateral reduced air entry (OR, 4.8; 95% CI, 3.5-6.5), witnessed choking (OR, 3.1; 95% CI, 1.0-9.6), wheezing (OR, 2.5; 95% CI, 1.2-5.2), and suspicious findings suggestive of FBA on radiography (OR, 18.5; 95% CI, 5.0-67.7) were the most commonly used predictor variables. Model performance varied, with discrimination scores (C statistic) ranging from 0.74 to 0.88. The pooled weighted C statistic score of all models was 0.86 (95% CI, 0.80-0.92). All studies were deemed to be at high risk of bias, with overfitting of models and lack of validation as the most pertinent concerns.

Conclusions and Relevance

This systematic review and meta-analysis suggests that existing CPMs for FBA in children are at a high risk of bias and have not been adequately validated. No current models can be recommended to guide clinical decision-making. Future CPM studies that adhere to recognized standards for development and validation are required.

Foreign body aspiration in a tertiary Syrian centre: A 7-year retrospective study

Background

Paediatric foreign body aspiration constitutes significant lethal sequela worldwide. This is the first descriptive Syrian study that aims to describe the epidemiology of foreign body aspiration in a tertiary centre in Syria.

Methods

This is a retrospective cohort study conducted at the Children's University Hospital, Damascus, from 2011 to 2018 during the Syrian crisis. The children underwent rigid bronchoscopy at Al Mouwasat University hospital, the only properly equipped hospital to perform paediatric rigid bronchoscopy in Damascus. We included all cases with complete medical records of children under the age of 13 years with positive bronchoscopy findings of foreign body aspiration. The records of patients were examined, and data extracted included physical examination, CXR reports, bronchoscopy reports, and complications. Statistical package for social sciences 25.0 program for Windows was used to report frequencies, percentages, means, medians, and standard deviations.

Results

Of 560 children diagnosed with foreign body aspiration, the peak incidence was at the age of 1–3 years 376 (67.2%). Most patients presented with an explicit history of inhalation 453 (80.9%). The most frequent clinical findings were dyspnoea 320 (57.1%), wheezing 308 (55%), and chest retraction 209 (37.35%). Hyperinflation 260 (46.4%) followed by pulmonary infiltration 197 (35.2%) were the most common abnormal radiological findings. Seeds 273 (48.8%) were the most frequent foreign body extracted by rigid bronchoscopy. The right main bronchus 255 (40.2%) was the most frequent site of foreign body lodgement. Lobar pneumonia 16 (2.8%) was the commonest complication of foreign body aspiration.

Conclusion

Foreign body aspiration is a major public health problem in Syria. The child's welfare must be our paramount concern. To prevent this accident, we should address a change in raising public health awareness with regards to appropriate food and eating habits. This would limit hazardous complications.

Recurrent Respiratory Tract Infection in a 24-Year-Old Female Secondary to a Foreign Body Aspiration

Foreign body aspiration (FBA) is a common problem necessitating prompt recognition and early treatment to minimize the potentially severe and sometimes fatal consequences. We presented a 24-year-old girl who was admitted for chronic cough and recurrent pneumonia associated with constitutional symptoms. She was feverish with a temperature of 39°C and had tachycardia and tachypnoea with an oxygen saturation of 98%. Investigations revealed leukocytosis. CXR showed right lower lobe consolidation, and CT thorax demonstrated collapse consolidation of the right middle and lower lobe, along with associated dilated segmental bronchioles and diffuse patch ground-glass opacity in both lung fields. Bronchoscopy revealed a pen cap at the entrance of the right lower lobe. Patient symptoms improved after removal of the foreign body. In patients with recurrent chest infection, the physician should check for the possibility of FBA and prompt for a referral to a tertiary center for further evaluation.

Value of multi-slice spiral computed tomography for diagnosis of tracheobronchial foreign body aspiration in children: 5-year retrospective study

BACKGROUND

Tracheobronchial foreign body (TFB) aspiration is a significant cause of respiratory problems in children. The timely diagnosis of TFB is important to decrease the mortality rate and the incidence of complications. Advances in radiology have led multi-slice spiral computed tomography (MSCT) to become the best technique for diagnosing TFB.

METHODS

We performed a retrospective study over 5 years from July 2008 to June 2013. We collected information on children who were diagnosed with a TFB by bronchoscopy, and analyzed age, sex, location, type of foreign body, and various MSCT manifestations.

RESULTS

A total of 382 children were included and 68.6% of them were aged 1 to <2 years. The majority (95.8%) of aspirated foreign bodies were vegetation items, and nearly half (47.6%) of them were peanut kernels, followed by sunflower seeds (26.2%). A total of 4.7% of TFBs were in the trachea, 51.0% were in the left main bronchus, and 44.2% were in the right main bronchus. Among the TFBs, 359 (95.5%) showed a high-density shadow in the tracheal / bronchial lumen using MSCT, which could establish the presence of a foreign body directly. Emphysema, localized obstruction and pneumonia were more commonly detected in the 7-21 days and ≥21 days group compared with those in the <7 days group (all P < 0.01). Bronchiectasis was found in two children who were diagnosed at least 21 days after aspiration.

CONCLUSIONS

Multi-slice spiral computed tomography is very sensitive to TFBs. Timely diagnosis and treatment of TFB is important to prevent long-term sequelae in children.

Cryoprobe retrieval of an airway foreign body: A case report and literature review

We report a case of a 7-year-old boy with clinical and radiographic evidence of foreign body (FB) aspiration with a 2-week delay in diagnosis. The retrieval of the pushpin with traditional bronchoscopic instrumentation was made difficult by granulation tissue formation. A cryoprobe through a flexible bronchoscope was used to successfully remove the FB. To our knowledge, this is the first report of interventional bronchoscopy with a cryoprobe to remove a pushpin in a child under suspension laryngoscopy and spontaneous ventilation. A high index of suspicion is crucial for identifying FBs early and minimizing granulation tissue development which complicates FB removal.

Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011-2018

OBJECTIVE

This study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy.

METHODS

The medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema.

RESULTS

Of the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7-156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups.

CONCLUSIONS

Foreign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.

Death as a Consequence of Foreign Body Aspiration in Children

Aim:

To analyze the rate of mortality in children with foreign body aspiration (FBA).

Methods:

We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded.

Results:

Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero.

Conclusion:

For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

Foreign body aspiration as a cause of cryptogenic hemoptysis in a child: A case report

RATIONALE

Hemoptysis is rare but potentially life-threatening condition in children. The most common cause of pediatric hemoptysis is lower respiratory tract infections. Sometimes foreign body aspiration may result in hemoptysis too.

PATIENT CONCERNS

A 4-year old girl suffered from recurrent cryptogenic hemoptysis for almost 2 years.

DIAGNOSES

The wheatear was finally found to be the underlying cause.

INTERVENTIONS

The girl received multiple bronchoscopy.

OUTCOMES

The girl's symptoms improved rapidly and remained well without relapse of hemoptysis.

LESSONS

This case indicates that foreign body aspiration should be considered in any child with recurrent cryptogenic hemoptysis and persistent focal lung injury. Multiple bronchoscopy is rational in order to find out the underlying reasons.

A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children

Distally impacted chronic tracheobronchial sharp foreign bodies in children are a management challenge that presents with clinical subtlety and extreme variability. The use of image guided techniques, imaginative instrumentation, tracheotomy, thoracotomy, and even extracorporeal membrane oxygneation have been reported. Endoscopy is made difficult by the distal location, inflammatory reaction with granulation tissue formation, and bleeding obscuring the foreign body. Our aim is to describe our experience with two children who had removal of aspirated impacted sharp metallic foreign bodies from the distal airway using rigid bronchoscopy, preceded by maximal medical therapy.

A Rare Incidental Finding of a Foreign Body in the Nasopharynx during Adenotonsillectomy

Diverse foreign bodies may become lodged in the aerodigestive tract, and the discovery of such foreign bodies is an expected scenario for health-care practitioners. The foreign body insertion may be accidental or deliberate, and the object may be organic or inorganic. Most accidental foreign body aspirations occur in children, and some such cases are potential threats that go unnoticed. Very few cases of foreign bodies in the nasopharynx have been reported. Herein, we describe an unusual case in which a foreign body in a child's nasopharynx went unnoticed for 1 year and was detected intraoperatively.

Predictors of complicated airway foreign body extraction

OBJECTIVES

To evaluate outcomes of foreign body aspiration (FBA) and to investigate surgeon and hospital volume as risk factors for a complicated course.

STUDY DESIGN

Retrospective case series.

METHODS

Children with FBA in a multihospital network were identified from January 2005 to September 2015. Demographic information, surgeon, and hospital location were reviewed. Mean operative time and hospital length of stay were recorded. Cases requiring intensive care unit admission, hospital stay greater than 24 hours, need for more than one bronchoscopy, operative time greater than 1 hour, or death were considered "complicated."

RESULTS

A total of 450 cases of airway foreign body extraction were performed. Patient ages ranged from 0.6 to 18.8 years, with a median age of 1.9 years. Bronchoscopy with foreign body extraction was performed by 55 different surgeons at 11 different facilities. There were one to 24 surgeons for each facility, with an average number of 5.4 surgeons per facility. A total of 88 (19.6%) cases were considered complicated, including five (1.1%) deaths. Increased rates of complications were seen with unwitnessed aspiration (P = 0.008) and hyperlucency (P < 0.001) or infiltrates (P = 0.001) on chest radiographs. No significant association was found between surgeon type or facility as related to a complicated case.

CONCLUSIONS

Unwitnessed aspiration events and abnormalities on chest radiograph may be associated with a more complicated course in children with FBA. This multihospital study identified a low number of procedures by many surgeons; however, surgeon and hospital volume did not significantly correlate with higher complication rates.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:490-495, 2018.

The bacterial species associated with aspirated foreign bodies in children

OBJECTIVE

Inhaled foreign bodies in children are common and may be complicated by secondary airway tract infection. The inhaled foreign body may act as carrier of infectious material and the aim of this study was to explore the bacterial species associated with aspirated foreign bodies in a cohort of children.

METHODS

Retrospective case series of 34 patients who underwent rigid laryngobronchoscopy because of foreign body aspiration. Each patient had a sample taken from tracheobronchial secretions during the procedure.

RESULTS

The average patient age was 31.2 months and the average hospital stay was 2.5 days. Of the foreign bodies 24 (71%) were organic in nature and 10 (29%) were non-organic. Twenty eight (82.3%) patients had mixed oropharyngeal flora organisms growth. Fifteen (44%) samples were positive for organisms other than oropharyngeal flora with the most common cultured organisms being: Streptococcus pneumonia (4/12%), Haemophilus influenza (4/12%), Moraxella catarrhalis (4/12%). Four samples (12%) grew a fungus; Candida albicans was cultured in 3 patients and Aspergillus glaucus was identified in one sample. Of the non-oropharyngeal organisms 7(47%) demonstrated antibiotic resistance with four having resistance to amoxycillin, two resistant to penicillin and one resistant to cotrimoxazole.

CONCLUSION

Some children who present with aspirated foreign body may be complicated with secondary airway infection. Antibacterial treatment might be considered in some of these cases. The regimen of antibiotics should aim to cover oropharyngeal flora, S. pneumonia, H. influenza and Moraxella catarrhalis.

Foreign body aspiration in children: Focus on the impact of delayed treatment

OBJECTIVE

This study aims to analyze the impact of delayed treatment of foreign body aspiration (FBA) in children.

MATERIALS AND METHODS

In this study, we retrospectively reviewed 220 children who were diagnosed with FBA through rigid bronchoscopy from January 2010 to May 2016 in our hospital. The time elapsed between aspiration event and arrival at our hospital exceeded 24 h was considered to have a delayed treatment. The occurrence rate of complications at admission, operation time and hospitalization time were compared between the delayed treatment group and non-delayed treatment group.

RESULTS

A total of 220 children diagnosed with FBA by rigid bronchoscopy were enrolled in this study, including 138(62.7%) boys and 82(37.3%) girls. The median age was 20 months. Only 102 (46.4%) cases came to our hospital within 24 h. The remaining 118 (53.6%) cases had a delayed treatment. The occurrence rate of complication at admission was significantly higher in the delayed treatment group than in the non-delayed treatment group (80.5% vs. 52.9%, P < 0.01). Delayed treatment group also had significantly longer operation time and hospitalization time than non-delayed treatment group (median operation time: 18min vs. 10min; median hospitalization time: 4d vs. 3d; both P < 0.01). In multivariate analysis, delayed treatment remained an independent risk factor for longer operation time (HR 2.47, 95% CI 1.13-5.44, P = 0.02) and longer hospitalization time (HR 2.19, 95% CI 1.23-3.88, P = 0.01).

CONCLUSION

Delayed treatment of FBA is not only related to higher occurrence rate of complication but also associated with longer operation and hospitalization time.

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

Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.

Long-standing inhaled foreign bodies in children: Characteristics and outcome

OBJECTIVE

Aspirated foreign bodies in children present a potentially life-threatening condition and can be challenging to diagnose. This study aims to elucidate the characteristics and outcome of children with long-standing aspirated foreign bodies.

METHODS

Retrospective case series of all cases of confirmed long-standing aspirated foreign bodies (LSAFB) between January 2003 to December 2015 in a single paediatric tertiary-level institution, defined as more than two weeks from choking episode or beginning of symptoms.

RESULTS

Clinical files and operative records on 227 patients were screened and 35 children were confirmed to have been treated for LSAFB as per definition above. Median time to presentation was 4 weeks (mean 8.8 weeks). Eighty-six percent presented with cough and 51% with dyspnoea. Abnormal chest X-ray findings were found in 28 out 31 patients (90%). Organic foreign bodies (22) were more common than inorganic (14). Intraoperative granulation tissue was demonstrated in 89% of patients and in 46% of patients this was regarded as significant (defined as obstructing more than 50% of the involved airway lumen). Mean length of stay was 2.5 days. Nine patients (26%) had 11 respiratory complications; there were no mortalities.

CONCLUSIONS

Paediatric LSAFB poses an uncommon diagnostic dilemma as there is often no witnessed history of aspiration event; and signs, symptoms and chest X-Ray findings are often non-specific. Laryngobronchoscopy is made more difficult by the presence of granulation tissue and the sequelae of prolonged non-treatment is a higher rate of chronic respiratory disease.

Imaging Acute Airway Obstruction in Infants and Children

Acute airway obstruction is much more common in infants and children than in adults because of their unique anatomic and physiologic features. Even in young patients with partial airway occlusion, symptoms can be severe and potentially life-threatening. Factors that predispose children to airway compromise include the orientation of their larynx, the narrow caliber of their trachea, and their weak intercostal muscles. Because the clinical manifestations of acute airway obstruction are often nonspecific, clinicians often rely on the findings at imaging to establish a diagnosis. Several key anatomic features of the pediatric airway make it particularly susceptible to respiratory distress, and the imaging recommendations for children suspected of having acute airway obstruction are presented. Although cross-sectional imaging may be helpful, the diagnosis can often be established by using radiographs alone. Radiographs of the chest and upper airway should be routinely acquired; however, for the child who is in severe distress, a single lateral radiographic view may be all that is necessary. The purpose of this article is to provide an imaging approach to acquired causes of acute airway obstruction in children, including (a) abnormalities affecting the upper portion of the airway, such as croup, acute epiglottitis, retropharyngeal infection, and foreign bodies, and (b) abnormalities affecting the lower portion of the airway, such as asthma, bronchiolitis, and foreign bodies. It is essential that the radiologist recognize key imaging findings and understand the pathophysiologic features of acute airway obstruction because in most cases, when the cause is identified, the condition responds well to prompt management.

Logistic regression analysis of risk factors for prolonged pulmonary recovery in children from aspirated foreign body

OBJECTIVE

Foreign body aspiration is a life-threatening emergency for children. Fried chicken is commonly available all over the world, but no cases have previously been reported addressing this food as a tracheobronchial foreign body. We report an extremely rare case of tracheobronchial aspiration of fried chicken complicated by severe bronchitis and postoperative atelectasis. To clarify predisposing factors related to bronchopulmonary complications, we also reviewed paediatric cases of tracheobronchial foreign bodies treated in our department over the past 14 years.

METHODS

We retrospectively reviewed a total of 77 cases of tracheobronchial foreign bodies from 1988 to 2011. The main outcome measure was duration of hospitalisation, reflecting postoperative therapy. Logistic regression analyses were conducted to determine risk factors for longer hospitalisation.

RESULTS

Age, sex, and interval between the aspiration episode and bronchoscopy were not significantly associated with longer hospitalisation. Regarding kinds of foreign bodies, higher rates of longer hospitalisation were noted for patients who had aspirated peanut or animal material, as compared to patients who had aspirated non-organic material (odds ratio, 5.80; 95% confidence interval, 1.12-30.43).

CONCLUSIONS

In terms of predicting the risk of pulmonary complications, the type of foreign body aspirated offers a more meaningful factor than the interval between aspiration and operation. Specifically, peanuts or animal material containing oils appear to be associated with a more prolonged pulmonary recovery even after retrieval of the foreign body.

Complicated and dislodged airway foreign body in an intubated child: case report

OBJECTIVE

We report a case of missed foreign body aspiration in a child presenting with status epilepticus. On admission, the patient was found to have pneumonia, which progressed to respiratory failure and acute respiratory distress syndrome. While the patient was intubated and mechanically ventilated, the patient experienced acute respiratory deterioration. Subsequently, it was determined that a previously undetected foreign body had dislodged from the right main to the left main bronchus and was the underlying cause for the child's illness.

CONCLUSIONS

A combination of sudden change of physical and radiographic findings with unilateral lung hyperinflation is highly suspicious for an obstructing airway foreign body. This case demonstrates that foreign body aspiration can lead to significant morbidity. It should be in the differential diagnosis for any acute pulmonary process in an otherwise well child because there is no specific clinical or radiographic finding to rule it out.

Suspected foreign body inhalation in children: what are the indications for bronchoscopy?

OBJECTIVE

To define the criteria for bronchoscopy in children with suspected foreign body (FB) inhalation.

STUDY DESIGN

Health history, physical examination, and radiologic examination were performed before bronchoscopy in all children referred for suspected FB inhalation between 2003 and 2005.

RESULTS

A total of 142 children, ranging in age from 3 months to 14 years (median age, 20 months), were referred with a history of suspected FB inhalation. An FB was found in 42 children with abnormal physical and radiologic findings, in 17 children with abnormal physical or radiologic findings, and in 2 children with normal physical and radiologic finding but persistent cough. Bronchoscopy revealed no FB in the children with normal physical and radiologic examinations and no symptoms (n = 16).

CONCLUSION

In children with a history of choking, bronchoscopy is mandatory in the presence of persistent symptoms, such as cough, dyspnea, and fever, or any abnormal physical or chest radiography findings. Bronchoscopy is not necessary in asymptomatic children with normal physical and radiographic examinations.

CT in children with suspected residual foreign body in airway after bronchoscopy

OBJECTIVE

The purpose of our study was to determine whether CT provides additional information for children with a suspected residual foreign body in the airway after bronchoscopy.

MATERIALS AND METHODS

We reviewed the CT findings and medical records of nine patients (five girls and four boys; mean age, 17.9 months) who underwent CT between March 1999 and February 2007 for the evaluation of a clinically suspected residual foreign body in the airway after bronchoscopy. We evaluated the location and pattern of bronchial obstruction and associated parenchymal abnormalities on CT. CT findings were compared with a second bronchoscopy in five patients. The remaining four patients were followed clinically. Association between CT findings and results on second bronchoscopy was evaluated with Fisher's exact test.

RESULTS

CT after bronchoscopy (n = 9) showed bronchial obstruction in eight patients with focal complete (n = 3), diffuse (n = 3), or combined type (n = 2) bronchial obstruction. These obstructions were not seen at chest radiography. CT revealed unilateral or lobar emphysema (n = 6), atelectasis (n = 6), and consolidation (n = 1). The remaining one patient showed no abnormality on CT. A second bronchoscopy (n = 5) confirmed the focal complete bronchial obstruction at CT (n = 3) as retained foreign body fragments (n = 2) or mucus plug (n = 1) and the combined type at CT (n = 2) as retained foreign body fragments, granulation tissue, and edema of the bronchus (n = 1) or retained foreign body fragments, granulation tissue, and mucus plug (n = 1). There was a significant association between CT findings of type of bronchial obstruction and intrabronchial obstructive lesion on the second bronchoscopy (p = 0.036).

CONCLUSION

CT after bronchoscopy can provide additional information regarding the presence and pattern of bronchial obstruction in children with a suspected residual foreign body.

Tracheobronchial foreign bodies in children. Experience at ORL clinic Tuzla, 1954-2004

OBJECTIVE

To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital.

SETTING

Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center Tuzla, Bosnia and Hercegovina.

METHOD

The analysis of the cases of aspirated foreign bodies within the period from January 1954 to December 2004. The analyzed patients were the children up to 14 years of age. All cases underwent the bronchoscopy. Each patient was analyzed for age, sex, nature and location of the foreign body, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways.

RESULTS

Six hundred and sixty-two children who underwent bronchoscopy for removal of foreign body in the airways were evaluated. From evaluated children 66.8% were boys, ages ranging from 9 months to 14 years. Foreign bodies were more frequent in children under 3 years of age (65.2%). Most of the foreign bodies removed were organic (87.1%) and more frequently found in the right bronchial tree (53%).

CONCLUSIONS

More attention is necessary to the prevention of aspirations. Prevention of aspiration of foreign bodies is better than cure. Public awareness through mass media needs attention to prevent foreign body inhalation.

Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms

BACKGROUND

Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay.

OBJECTIVES

To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis.

METHODS

We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed.

RESULTS

During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis.

CONCLUSIONS

Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.

Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration

BACKGROUND

Foreign body aspiration is common in children, especially those under 3 years of age. Chest radiography and CT are the main imaging modalities for the evaluation of these children. Management of children with suspected foreign body aspiration (SFBA) mainly depends on radiological findings.

OBJECTIVE

To investigate the potential use of low-dose multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation and management of SFBA in children.

MATERIALS AND METHODS

Included in the study were 37 children (17 girls, 20 boys; age 4 months to 10 years, mean 32 months) with SFBA. Chest radiographs were obtained prior to MDCT in all patients. MDCT was performed using a low-dose technique. VB images were obtained in the same session. Conventional bronchoscopy (CB) was performed within 24 h on patients in whom an obstructive abnormality had been found by MDCT and VB.

RESULTS

Obstructive pathology was found in 16 (43.25%) of the 37 patients using MDCT and VB. In 13 of these patients, foreign bodies were detected and removed via CB. The foreign bodies were located in the right main bronchus (n = 5), in the bronchus intermedius (n = 6), in the medial segment of the middle lobe bronchus (n = 1), and in the left main bronchus (n = 1). In the remaining three patients, the diagnosis was false-positive for an obstructive pathology by MDCT and VB; the final diagnoses were secretions (n = 2) and schwannoma (n = 1), as demonstrated by CB. In 21 patients in whom no obstructive pathology was detected by MDCT and VB, CB was not performed. These patients were followed for 5-20 months without any recurrent obstructive symptomatology.

CONCLUSIONS

Low-dose MDCT and VB are non-invasive radiological modalities that can be used easily in the investigation of SFBA in children. MDCT and VB provide the exact location of the obstructive pathology prior to CB. If obstructive pathology is depicted with MDCT and VB, CB should be performed either for confirmation of the diagnosis or for the diagnosis of an alternative cause for the obstruction. In cases where no obstructive pathology is detected by MDCT and VB, CB may not be clinically useful.

Diagnostic evaluation of foreign body aspiration in children: a prospective study

AIM

The aim of this study was to evaluate the yield of clinical symptoms, signs, and radiological studies in the diagnosis of foreign body aspiration (FBA) in children.

METHODS

During the 2-year study, we performed on all children admitted to the pediatric department for suspected FBA a protocol that included the following: thorough medical history, physical examination, radiological studies (chest x-ray and fluoroscopy), and rigid bronchoscopy by a senior otolaryngologist. The yield of these measures for the diagnosis of FBA was evaluated.

RESULTS

Foreign bodies were found in 56 (57%) of the 98 children with suspected FBA. Thirty-three (59%) children were boys and 23 (41%) girls (P < .05), with a mean age of 24 months (range, 8-84 months). Main symptoms in the children with FBA were the following: choking (76.8%), prolonged cough (14.3%), dyspnea (3.6%), and nonresolving pneumonia (1.8%). Physical examination, chest x-ray, and fluoroscopy findings were abnormal in 80.4%, 67.9%, and 46.9% of the children with FBA, respectively. The diagnostic yield of physical examination and radiological studies increased 24 hours after the event of FBA. In 45.2% of the children with positive history but with normal findings from physical examination and radiological studies, foreign bodies were found. Of the children with "doubtful" history, physical examination, chest x-ray, and fluoroscopy findings were abnormal in 58%, 38%, and 12.5%, respectively. Foreign bodies were found in 9.5% of these children.

CONCLUSION

Medical history is the key for the diagnosis of FBA. Choking followed by an acute episode of coughing is the most common presentation of FBA. The yield of physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. If FBA is suspected, bronchoscopy should be performed.

Metastatic intracranial abscesses of bronchopulmonary origin

Intracranialabscesses are serious, life-threatening infections despite recent advances in diagnosis and treatment. We report the case of a child with metastatic brain abscesses and a chronic, sharp foreign body of the bronchus. Its presentation and endoscopic appearance and the microbiology of the abscesses are detailed. The detection of bacteria of respiratory origin should lead to a search for a bronchopulmonary source of contamination.

Foreign body aspiration: what is the outcome?

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. We reviewed a total of 174 children with foreign body aspiration (FBA). Clinical, radiological, and bronchoscopic findings of these patients were evaluated according to the nature of foreign body and elapsed time from aspiration to diagnosis. Significant differences were noted between patients with organic and inorganic FBA in terms of clinical and radiological findings. Cough, recurrent pneumonia, and fever were the most common presenting symptoms in patients with delayed diagnosis. Long-term follow-up was available for 110 patients for a mean duration of 37.8 +/- 23.7 months (range, 1-88 months). We evaluated the course of recovery after bronchoscopic removal. Organic FBA was of comparable duration as for inorganic FBA, and prolonged follow-up was associated with increased risk of persistent symptoms and bronchiectasis (P < 0.001). The risk of long-term complications increased with increasing elapsed time from aspiration to diagnosis; complications were as high as 60% in children who were diagnosed 30 days after FBA (P = 0.0035). Bronchiectasis was a major complication, found in 25% of patients whose diagnosis was delayed by more than 30 days (P = 0.0001). Three patients with bronchiectasis underwent lobectomy. Patients with persistent asthma-like symptoms such as cough and wheezing required treatment with inhaled corticosteroids and bronchodilators. The positive response to this treatment was thought to be a confirmation of the development of transient bronchial hyperresponsiveness induced by foreign bodies. We conclude that timely diagnosis and appropriate treatment of FBA is important to prevent long-term complications in affected children.

Effects of intrabronchial foreign body retention

Unrecognized bronchial foreign bodies (Fbs) cause irreversible changes in the airways. However, the exact course of these changes is not well-known. We developed an animal model of bronchial obstruction to radiologically and histopathologically assess the development of postobstructive pulmonary changes. A piece of peanut was placed in the airways of 21 rabbits through a 2.5-mm rigid bronchoscope. Animals were divided into three groups (groups I-III) that were sacrificed on day 3,10, and 30 after Fb placement, respectively. Prior to sacrifice, since there were no differences between the groups prior to Fb placement, computerized tomography (CT) of the lung was taken, and the lungs were harvested for histologic analysis under light microscope. In group I, leukocyte infiltration around the bronchial wall (P = 0.0003) and edema (P = 0.0384) around the alveolar septa were the predominant histological findings. The CT scan was normal. In group II and group III, increased amounts of mononuclear cells and macrophage infiltration around the bronchial wall were observed (P = 0.0008, P = 0.0409, respectively). There were no differences in presence of granuloma formation, emphysema, atelectasis, or thickness of alveolar septa among the three groups. The CT scan of group II showed consolidations plus minimal bronchial dilatation in the involved lung of the rabbits (P not significant). Bronchial cartilage destruction was seen in 4 out of 7 rabbits in group III (P = 0.0071). We conclude that 30-day retention of intrabronchial peanut caused bronchial cartilage destruction and fibrosis that were attributed as bronchiectatic changes in the airways of the lung parenchyma. Therefore, any case with suspected foreign body aspiration should be treated immediately to prevent possible irreversible changes of the lungs.

The combined use of a Fogarty balloon with extraction forceps for the controlled retrieval of an endobronchial foreign body

Foreign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal consequences. We report the case of a 7 year old girl with a peanut lodged in her right main bronchus. Bronchoscopy identified the foreign body which was then removed by the combined use of a Fogarty balloon catheter and extraction forceps. This case differs from previous reports, in that the foreign body and forceps were removed separately from the balloon catheter, which theoretically should minimize the risks associated with this procedure.

Endobronchial cockroach: an unusual foreign body aspiration

Foreign-body aspiration is a frequent and potentially lethal occurrence in children. It is associated with a variety of symptoms including choking, coughing, and wheezing. These symptoms differ in severity and are sometimes absent, and chest radiograph findings are often nonspecific. Thus, the diagnosis of foreign body aspiration is occasionally missed or delayed. A multitude of aspirated objects have been reported in the literature. In the present report, we describe the aspiration of a cockroach by a child with a delay in diagnosis of 3 d.