1
|
Alshaikh AA, Alhelali A, Hassan AA, Asiri MYA, Bukhari LKT, Hassan AAH, Hassan AAH, Alqahtani RSH, AlQahtani RY, Ghazy RM. Community experience and awareness regarding foreign body aspiration in Asir region, Kingdom of Saudi Arabia. Medicine (Baltimore) 2024; 103:e38869. [PMID: 39093731 PMCID: PMC11296466 DOI: 10.1097/md.0000000000038869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/19/2024] [Indexed: 08/04/2024] Open
Abstract
Foreign body aspiration (FBA) is a serious preventable pediatric health problem and one of the main causes of accidental death in children. Although unusual in adults, it is often overlooked as a cause of airway obstruction with serious consequences. This study assessed awareness and previous FBA experiences in the Asir community, Kingdom of Saudi Arabia. Using validated questionnaire, an annonymous online survey was conducted among 870 people aged 18 years and above. The questionnaire was used to collect data about the personal and sociodemographic characteristics of the respondents, as well as their experiences with FBA, and participants' knowledge and perceived seriousness of FBA. The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%The level of knowledge was deemed good if the score ranged between 60% and 100%, and bad if the score fell below 60%. The majority of the participants (79.7%) were females, 48.1% were aged 18 to 30 years, 72.9% had university degree, 30.6% were students, 26.9% worked in the educational sector, 43.6% reported monthly income of <5000 Saudi Riyals and 19.8% of them identified themselves as healthcarepractitioners. Although the community experience with FBA was considerably high (70.6%) among the study participants, their awareness levels about FBA were deficient. Only 24.7% of the respondents had good knowledge of FBA. Older age, being a health practitioner, and perceiving FBA as a serious incident were significantly associated with good knowledge (P < .001). The findings of this study indicate an urgent need to raise community awareness of FBA. To reduce FBA morbidity and mortality, health education efforts in community and healthcare settings are required to educate people about the seriousness and importance of early diagnosis and management of the condition.
Collapse
Affiliation(s)
- Ayoub Ali Alshaikh
- Family & Community Medicine Department, King Khalid University, College of Medicine Abha, Abha, Saudi Arabia
| | - Abdullah Alhelali
- Abha Children Hospital, Aseer Central Hospital, Head of Airway/Laryngology Unit – Aseer, Central Hospital, Abha, Saudi Arabia
| | - Abdulrahim Ali Hassan
- Otorhinolaryngology, Head and Neck Surgery, Armed Forced Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | | | | | | | | | | | - Ramy Mohamed Ghazy
- Family & Community Medicine Department, King Khalid University, College of Medicine Abha, Abha, Saudi Arabia
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| |
Collapse
|
2
|
Doppalapudi S, Fortuzi K, Qasim A, Yordanka DS, Khaja M. Glass in the Airways: A Bronchoscopic Challenge. Cureus 2024; 16:e53344. [PMID: 38435889 PMCID: PMC10907552 DOI: 10.7759/cureus.53344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever. These varied presentations, coupled with the fact that many other medical conditions can mimic the respiratory symptoms seen in FBA, make diagnosis challenging. A high index of suspicion is often required, especially in cases where the patient's history does not clearly point toward aspiration. Immediate management focuses on supporting the airway, which is crucial given the potential for severe obstruction. Radiographic imaging plays a key role in localizing the foreign body, which is vital for planning its removal. Bronchoscopy, particularly flexible bronchoscopy, is the cornerstone of both diagnosis and treatment. This technique allows for direct visualization of the airways, localization of the foreign body, and its subsequent removal. This is crucial to avoid long-term complications, which can arise if the foreign body is not promptly and effectively removed. In this case report, we present a 64-year-old female patient who was found to have a foreign object positioned in the right lower lobe of the lungs that was removed via flexible bronchoscopy.
Collapse
Affiliation(s)
- Sai Doppalapudi
- Pulmonary and Critical Care Medicine, BronxCare Hospital, New York City, USA
| | - Ked Fortuzi
- Pulmonary Medicine, BronxCare Hospital, New York City, USA
| | - Abeer Qasim
- Internal Medicine, BronxCare Hospital, New York City, USA
| | | | | |
Collapse
|
3
|
Tao X, Li S, Wu L, Chen Z, Wang Y. A missed foreign body aspiration masquerading as congenital pulmonary airway malformation in a nine-year-old boy: A case report and literature review. Respir Med Case Rep 2023; 46:101955. [PMID: 38124993 PMCID: PMC10731667 DOI: 10.1016/j.rmcr.2023.101955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Although airway foreign body aspiration (FBA) is a common occurrence in any age group, unrecognized and retained foreign bodies in lungs may result in severe complications, such as lung abscess or bronchiectasis. In rare cases, FBA may present with similar clinical features as many other diseases (e.g. asthma, tumor, pulmonary eosinophilia). Here, we report a rare case of missed FBA in a nine-year-old boy, whose chest CT scan was suggestive of a cavitary lesion in the left lower lobe mimicking congenital pulmonary airway malformation (CPAM). However, surprisingly, flexible bronchoscopy revealed a peanut lodged in the lateral basal segment of left lower lobe, which was subsequently retrieved by a forceps and avoided unnecessary surgical lobectomy. Therefore, FBA can mimic other disorders (e.g. CPAM), and a high index of suspicion and additional diagnostic techniques (e.g. flexible bronchoscopy) may be required to distinguish them. Additionally, FBA should be considered in the differential diagnosis of respiratory disorders in children even lack of aspiration history.
Collapse
Affiliation(s)
- Xiaofen Tao
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Shuxian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Lei Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Zhimin Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Yingshuo Wang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| |
Collapse
|
4
|
Lin FZ, Cao W, Xu B, Liu J, Bi J, Fu Y. Risk Factors for Lower Respiratory Tract Infection Associated With Tracheobronchial Foreign Body Aspiration in Children. Ann Otol Rhinol Laryngol 2023; 132:1228-1232. [PMID: 36564908 DOI: 10.1177/00034894221143583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Fu-Zhi Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Lab of Genetic and Developmental Disorder, Hangzhou, Zhejiang Province, China
| | - Wei Cao
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Bin Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jia Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jing Bi
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yong Fu
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Zhejiang Provincial Key Lab of Genetic and Developmental Disorder, Hangzhou, Zhejiang Province, China
| |
Collapse
|
5
|
Pradhan P, Parida PK. Use of Dormia Basket for Retrieval of Tracheobronchial Foreign body. Indian J Otolaryngol Head Neck Surg 2023; 75:1092-1094. [PMID: 37274983 PMCID: PMC10234951 DOI: 10.1007/s12070-022-03334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background It is always challenging to remove a long-standing smooth spherical foreign body through standard optical forceps. These foreign bodies do not negotiate with the traditional optical forceps and the chance of dislodgement during the surgery is high. Instead, a Dormia basket can be effectively used to remove these foreign bodies. Case report: We have reported two cases of smooth spherical bronchial foreign bodies, which were failed with the standard optical forceps and later successfully retrieved with a Dormia basket. Conclusion Dormia basket can be effectively used to remove smooth spherical bronchial foreign bodies in children not amenable to the standard bronchoscopic forceps and later can be added to the standard tool in the foreign body retrieval kit for the otolaryngologist who deals with rigid bronchoscopy on a routine basis.
Collapse
Affiliation(s)
- Pradeep Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Pradipta Kumar Parida
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| |
Collapse
|
6
|
Golan-Tripto I, Tsabari R, Picard E, Stafler P, Armoni Domany K, Goldbart AD, Aviram M, Gatt D, Bari R, Tsaregorodtsev S, Peled C, Melnik P, Bar-Yoseph R, Gut G. Foreign body aspiration in Israeli children during the COVID-19 pandemic. Pediatr Pulmonol 2023; 58:425-432. [PMID: 36224102 DOI: 10.1002/ppul.26203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19 pandemic, in comparison to the prior years. METHODS In this retrospective multicenter study, we compared the number of children who presented with FBA during the COVID-19 year (March 1, 2020 to February 28, 2021) to the annual average of the years 2016-2019. We also compared the lockdown periods to the postlockdown periods, and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. RESULTS A total of 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior 4 years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in postlockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (average of 15.4% vs. 30.4%, p = 0.001). CONCLUSION There were fewer cases of pediatric FBA during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision, with no difference in the prevalence of FBA during the COVID-19 year.
Collapse
Affiliation(s)
- Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Tsabari
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Pulmonology Unit and Cystic Fibrosis Center, Pediatric Department, Hadassah Medical Center, Jerusalem, Israel
| | - Elie Picard
- Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aviv D Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvir Gatt
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Chilaf Peled
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pesah Melnik
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel
| |
Collapse
|
7
|
Muacevic A, Adler JR, Goh BS. The Mysterious Whistling Breath: Foreign Body Aspiration. Cureus 2023; 15:e34267. [PMID: 36855495 PMCID: PMC9968441 DOI: 10.7759/cureus.34267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Foreign body aspiration is commonly seen in the pediatric age group and can be a life-threatening condition. Typical presentations include coughing, wheezing, and choking and can often masquerade as asthma causing misdiagnosis and treatment delay. Most of the time, the actual aspiration event is unnoticed, and patients may remain asymptomatic until they present with recurrent infections with or without positive radiological findings. Aspirated objects tend to migrate distally, and organic objects may induce edema and inflammation. Diagnosis is crucial as near-total or total obstruction of the airway may cause asphyxia and, subsequently, death if no immediate intervention is taken.
Collapse
|
8
|
Shao H, Li S, He J, Wu L, Chen Z. A combination of flexible and rigid bronchoscopy in the successful removal of a residual fish bone from a peripheral bronchus: A case report. Front Pediatr 2023; 11:1114043. [PMID: 36896398 PMCID: PMC9989009 DOI: 10.3389/fped.2023.1114043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Although rigid bronchoscopy remains the gold standard for the management of foreign body (FB) inhalation, sometimes it still misses residual FBs. Inhalation of sharp FBs by infants is an uncommon but hazardous occurrence, which presents a significant challenge and demands expertise in therapeutic bronchoscopy. Particularly, residual sharp FBs in the peripheral tracheobronchial tree may pose challenging management problems for bronchoscopists. Herein, we describe the case of 1-year-old girl, who presented with persistent atelectasis in the left lower lobe for 20 days without responding to antibiotic therapy after removal of fish bone by rigid bronchoscopy at local hospital. Flexible bronchoscopy at our department showed a residual fish bone in the outer basal segment of the left lower lobe. A combined flexible and rigid bronchoscopy was then applied, and a fish bone measuring 1.5 cm in length was extracted on multiple attempts without any complications. Thus, our reports demonstrated that removal of challenging residual sharp FBs in the distal airways is possible with the aid of combined flexible and rigid bronchoscopy by an experienced multidisciplinary team. Additionally, a physician should pay special attention to abnormal chest images after removal of FBs.
Collapse
Affiliation(s)
- Hanqing Shao
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuxian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jing He
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
9
|
Nuts and Beans Aspiration in Children-Positive Respiratory Virus Does Not Rule Out Foreign Body Aspiration. Pediatr Emerg Care 2022; 38:e1698-e1699. [PMID: 35802486 DOI: 10.1097/pec.0000000000002803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
10
|
Bukhari DH, Kabli AF, Alharthi TS, Sendi E, Rashed AA. A Rare Case of a Vocal Cord Foreign Body in an Infant: A Case Report. Cureus 2022; 14:e29213. [PMID: 36259039 PMCID: PMC9569188 DOI: 10.7759/cureus.29213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
A foreign body (FB) is an object or item that is foreign to the area in which it is found. FB in the airway, accompanied by the esophagus, is a common overnight emergency in pediatric otolaryngology. Here we report a case of a healthy 11-month-old girl who presented in the emergency room with stridor and a weak cry. The patient was admitted as a case of croup (laryngotracheobronchitis) and treated with multiple antibiotics for more than five days but showed no improvement, then consulted the ear, nose, and throat team (ENT).
Collapse
|
11
|
Lei W, Gan ZY, Liang YF, Liang CX, Jin CZ, Peng WP, Qiu XC, Guo HY. Airway foreign body caused by pepper inhalation 7 years previously retrieved under conscious sedation with spontaneous respiration: a case report. J Int Med Res 2022; 50:3000605221086146. [PMID: 35296168 PMCID: PMC8943315 DOI: 10.1177/03000605221086146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old man who had inhaled a dried pepper 7 years previously was admitted to our hospital for repeated coughing with yellow sputum and occasional hemoptysis. A thoracic high-resolution computed tomography scan revealed a foreign body at the proximal end of the right lower bronchus. We attempted to remove the foreign body by flexible bronchoscopy, but this was unsuccessful because the foreign body fell deeper into the bronchus. After a multidisciplinary team meeting, the foreign body was successfully extracted by bronchoscope suction and forceps under conscious sedation with spontaneous respiration. We avoided rigid bronchoscopy and traumatic surgery, thus decreasing the patient's risk and cost. We herein share our successful experience with this case.
Collapse
Affiliation(s)
- Wei Lei
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China.,Southern Medical University, Guangzhou City, Guangdong Province 510515, China
| | - Zhen-Yong Gan
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Yong-Feng Liang
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Cai-Xia Liang
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Cang-Zheng Jin
- Department of Radiology, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Wei-Ping Peng
- Department of Anesthesiology, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Xin-Cai Qiu
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Hai-Yan Guo
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| |
Collapse
|
12
|
Paap MK, Leuin S, Carvalho D. Pediatric Foreign Body Aspiration: Time of Occurrence and Factors Affecting Outcomes. Pediatr Emerg Care 2022; 38:e958-e960. [PMID: 34282090 DOI: 10.1097/pec.0000000000002503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of this study was to assess which factors could affect outcomes in pediatric patients undergoing bronchoscopy for foreign body aspiration (FBA). METHODS This is a retrospective case series study evaluating patients who underwent bronchoscopies because of FBA at a tertiary pediatric hospital between January 1, 2010, and December 6. 2018. Data collected included demographic information, time of the aspiration event, history of developmental delay, time of the procedure, duration of the procedure, and outcome (discharged, admission to the hospital or pediatric intensive care unit [PICU], or deceased). Statistical analysis was performed using standard regression analysis and analysis of variance. RESULTS There were a total of 114 patients who underwent bronchoscopy for FBA (61% male and 39% female). The mean ± SD age was 2.8 ± 3.4 years, and 16% had developmental delay. The mean age for patients with developmental delay was 3.43 years, compared with 1.69 years for patients without developmental delay. The age difference between these 2 groups was statistically significant (P = 0.0047). The most commonly aspirated object was food (57%), and patients were usually with their parents at the time of aspiration (78%). Most aspiration events (57%) happened between 4 pm to 4 am. The mean ± SD time of procedure was 38 ± 28 minutes. The probability of admission to the hospital, PICU, and death increased with the duration of the procedure (P < 0.001). Patients with procedures longer than 60 minutes had a 40% probability of admission to the PICU, and patients with cases longer than 120 minutes had 13% probability of mortality. CONCLUSIONS Most FBA s occurred in the evening while the children were with their parents. Education of families regarding the risk of aspiration is crucial, so they are always attentive to this issue. Although the focus on prevention tends to be with younger patients, it is essential to emphasize the risk of FBA in older patients with developmental delay. Because most episodes of aspiration occur later in the day, it is imperative that tertiary pediatric centers ensure that the evening staff is trained and have the available equipment for these complex cases.
Collapse
Affiliation(s)
- Michael K Paap
- From the University of California, San Diego School of Medicine, La Jolla, CA
| | | | | |
Collapse
|
13
|
Lee JH, Kim SJ. Characteristics and outcomes of emergency department patients with a foreign body that entered through the ear, nose or mouth: a 10-year retrospective analysis. J Laryngol Otol 2021; 135:1-7. [PMID: 34674776 DOI: 10.1017/s0022215121002747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Foreign bodies in the ear, nose and throat commonly necessitate emergency department visits. METHOD This retrospective study was conducted on emergency department visits from January 2010 to December 2019 to determine characteristics and clinical prognoses of ENT patients. Patients were divided into three groups according to foreign-body entry route; patient characteristics and clinical findings were compared between groups. RESULTS Of 676 142 emergency department visits, 10 454 were because of ENT-related foreign bodies. The mean (± standard deviation) age of subjects was 24.0 (± 23.4) years, and 5176 patients were male (49.5 per cent). The most common entry route was the mouth (74.5 per cent). Most patients (97.1 per cent) were discharged after emergency treatment. Intensive care and in-hospital mortality occurred only in the mouth group. CONCLUSION Clinical findings differ depending on foreign-body entry route. After emergency treatment, most patients were discharged; some cases presented serious complications.
Collapse
Affiliation(s)
- J H Lee
- Department of Emergency Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| |
Collapse
|
14
|
Zhu Y, Fan Q, Cheng L, Chen B. Diagnostic Errors in Initial Misdiagnosis of Foreign Body Aspiration in Children: A Retrospective Observational Study in a Tertiary Care Hospital in China. Front Pediatr 2021; 9:694211. [PMID: 34722414 PMCID: PMC8555661 DOI: 10.3389/fped.2021.694211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Foreign body aspiration (FBA) in children is a common emergency that can easily be missed, leading to delays in treatment. Few large cohort studies have focused on errors in diagnostic assessment. The main purpose of this study was to analyze factors contributing to the initial misdiagnosis of FBA in children. Methods: We retrospectively reviewed the charts of 226 children diagnosed with FBA at the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2018 to November 2020. Cases were divided into two groups according to whether or not patients were initially misdiagnosed. The clinical characteristics of the two groups were then compared. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was applied to cases with initial misdiagnosis. Results: Of the 226 included children with a final diagnosis of FBA, 153 (67.7%) were boys. Ninety percent of patients were under 3 years old. More than half (61.9%) of the children were referred from primary institutions, and 38.1% visited tertiary hospitals directly. A total of 80 (35.4%) patients were initially misdiagnosed. More than half of misdiagnosed children received an alternative diagnosis of bronchiolitis (51.3%), the most common alternative diagnosis. Test failures (i.e., errors in test ordering, test performance, and clinician processing) were primarily responsible for the majority of initial diagnostic errors (76.3%), followed by failure or delay in eliciting critical case history information (20.0%). Characteristics significantly associated with initial misdiagnosis were: presentation over 24 h (OR 9.2, 95% CI 4.8-17.5), being referred from primary institutions (OR 8.8, 4.1-19.0), no witnessed aspiration crisis (OR 7.8, 3.0-20.3), (4) atypical signs or symptoms (OR 3.2, 1.8-5.7), foreign body not visible on CT (OR 36.2, 2.1-636.8), foreign body located in secondary bronchi (OR 4.8, 1.3-17.2), organic foreign body (OR 6.2, 1.4-27.2), and history of recurrent respiratory infections (OR 2.7, 1.4-5.3). Children with misdiagnosis tended to have a longer time from symptom onset to the definitive diagnosis of FBA (P < 0.001). Conclusions: More than one-third of children with FBA were missed at first presentation. Errors in diagnostic testing and history taking were the main reasons leading to initial misdiagnosis.
Collapse
Affiliation(s)
- Yingchao Zhu
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qijun Fan
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lijun Cheng
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Bobei Chen
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
15
|
Paudel D, Dahal R, Sah BP, Chettri ST, Gajurel P. A rare case of foreign body aspiration presenting as subglottic stenosis: A case report. Clin Case Rep 2021; 9:e04992. [PMID: 34721859 PMCID: PMC8538007 DOI: 10.1002/ccr3.4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/06/2021] [Accepted: 10/08/2021] [Indexed: 11/11/2022] Open
Abstract
In rare cases, foreign body aspiration may present with similar clinical features and CT findings to subglottic stenosis. A high index of suspicion and additional diagnostic techniques may be required to distinguish them.
Collapse
Affiliation(s)
- Deepak Paudel
- Department of ENT and Head & Neck SurgeryBPKIHSDharanNepal
| | - Raunak Dahal
- Department of ENT and Head & Neck SurgeryBPKIHSDharanNepal
| | | | | | - Pravid Gajurel
- Department of ENT and Head & Neck SurgeryBPKIHSDharanNepal
| |
Collapse
|
16
|
Golan-Tripto I, Mezan DW, Tsaregorodtsev S, Stiler-Timor L, Dizitzer Y, Goldbart A, Aviram M. From rigid to flexible bronchoscopy: a tertiary center experience in removal of inhaled foreign bodies in children. Eur J Pediatr 2021; 180:1443-1450. [PMID: 33389071 DOI: 10.1007/s00431-020-03914-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/06/2023]
Abstract
Rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies. In this retrospective study, we assessed the safety and efficacy of flexible bronchoscopy use in the removal of inhaled foreign bodies in children. One hundred eighty-two patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy for the removal of inhaled foreign body between 2009 and 2019, 40 (22%) by flexible, and 142 (78%) by rigid bronchoscopy. 88.73% of rigid and 95% of flexible bronchoscopies were successful in foreign bodies removal (p value = 0.24). Complication rate was higher among rigid bronchoscopy (9.2% vs. 0%, p = 0.047). From 2017 onwards, following the implementation of flexible bronchoscopy for foreign bodies removal, 64 procedures were performed, 33 (51.6%) flexible, and 31 (48.4%) rigid. Procedure length was shorter via flexible bronchoscopy (42 vs 58 min, p = 0.016). Length of hospital stay was similar.Conclusion: In our hands, flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time and minimal complication rate. Flexible bronchoscopy could be considered as the procedure of choice for removal of inhaled foreign bodies in children, by an experienced multidisciplinary team. What is Known: • Rigid bronchoscopy is currently the gold standard for removal of inhaled foreign bodies in children. • Rigid bronchoscopy has a relatively high complication rate compared to flexible bronchoscopy. What is New: • Flexible bronchoscopy is a short, safe, and efficient procedure to remove inhaled foreign bodies in children, compared to rigid bronchoscopy. • Flexible bronchoscopy could be proposed as the procedure of choice for removal of inhaled foreign bodies in children, if an experienced operator is available.
Collapse
Affiliation(s)
- Inbal Golan-Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel. .,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel.
| | - Dina Weinstein Mezan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical Care, Soroka University Medical Center, Beer Sheva, Israel
| | - Liran Stiler-Timor
- Department of ENT Surgery, Soroka University Medical Center, Beer Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
| |
Collapse
|
17
|
Antón-Pacheco JL, Martín-Alelú R, López M, Morante R, Merino-Mateo L, Barrero S, Castilla R, Cano I, García A, Gómez A, Luna-Paredes MC. Foreign body aspiration in children: Treatment timing and related complications. Int J Pediatr Otorhinolaryngol 2021; 144:110690. [PMID: 33799103 DOI: 10.1016/j.ijporl.2021.110690] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/03/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE The aims of this study were to describe our experience in the management of FB aspiration in children, focusing on the eventual association between delay in treatment and the development of complications, and to determine if the incidence of this emergency had decreased in the last 10 years. METHODS Retrospective study of children with a diagnosis of FB aspiration managed between 1999 and 2019 at a tertiary care referral hospital. The following data were collected: demographics, clinical presentation, radiological findings, endoscopic technique, type of FB, time elapsed between the aspiration episode and treatment, and complications. Main outcome measures were the rate of complications (intraoperative and long-term) in the cohort of patients with delay in treatment (>72 h), and the incidence of FB aspiration in each of the two historical subgroups of the study. RESULTS The study included 130 patients, 66.2% male, with a median age of 24 months. Cough was the most frequent symptom (76.1%) and unilateral air trapping was the most common radiological finding (48.8%). Removal of FB was performed with rigid bronchoscopy in every case. The most common type of FB was organic (73%) and located in the right bronchial system (47.7%). The global rate of complications was 16.1%. Patients with a delay in treatment beyond 72 h from the aspiration episode showed a statistically significant risk of developing both intraoperative and postoperative complications. Additionally, we have stated that the incidence of FB aspiration in our community has decreased by 44.4% in the last 10 years. CONCLUSIONS The incidence of FB aspiration has remarkably decreased in our environment in the last decade. Delay in treatment placed our patients at a significant higher risk of developing complications both during the bronchoscopic procedure and in the long-term.
Collapse
Affiliation(s)
- Juan L Antón-Pacheco
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Spain.
| | | | - María López
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| | - Rocío Morante
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| | - Lara Merino-Mateo
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Sergio Barrero
- School of Medicine, Universidad Complutense de Madrid, Spain
| | - Rubén Castilla
- School of Medicine, Universidad Complutense de Madrid, Spain
| | - Indalecio Cano
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Araceli García
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Andrés Gómez
- Division of Pediatric Surgery, Hospital U. 12 de Octubre, Madrid, Spain
| | - Ma Carmen Luna-Paredes
- Division of Pediatric Surgery & Pediatric Airway Unit, Hospital U, 12 de Octubre, Madrid, Spain
| |
Collapse
|
18
|
Mathew RP, Liang TIH, Kabeer A, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the paediatric population: Part 2. SA J Radiol 2021; 25:2027. [PMID: 33936796 PMCID: PMC8063769 DOI: 10.4102/sajr.v25i1.2027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
Children, especially toddlers, because of their behaviour, physiology and anatomical characteristics such as oral exploration of their surroundings, have a tendency to place objects in their mouth. Therefore, ingestion or aspiration of foreign bodies (FBs) in children is a potentially life-threatening and common problem seen across the world. In this second part of our pictorial review on ingested and aspirated FBs, we focus on the paediatric population, reviewing the current literature and examining the epidemiology, clinical presentation, anatomic considerations, appropriate imaging modalities, key imaging characteristics associated with clinically relevant FBs in the emergency department (ED) and current management protocols.
Collapse
Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Teresa I-Han Liang
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Ahamed Kabeer
- Department of Pediatric Surgery, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| |
Collapse
|
19
|
Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, Bush A, Chalmers JD, Hill AT, Karadag B, Midulla F, McCallum GB, Powell Z, Snijders D, Song WJ, Tonia T, Wilson C, Zacharasiewicz A, Kantar A. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021; 58:13993003.02990-2020. [PMID: 33542057 DOI: 10.1183/13993003.02990-2020] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 "Patient, Intervention, Comparison, Outcome" [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.
Collapse
Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Southport, Queensland, Australia
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Leanne Bell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group, Alnwick, United Kingdom
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring Vienna, Wien, Austria
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
| |
Collapse
|
20
|
Zoizner-Agar G, Merchant S, Wang B, April MM. Yield of preoperative findings in pediatric airway foreign bodies - A meta-analysis. Int J Pediatr Otorhinolaryngol 2020; 139:110442. [PMID: 33068947 DOI: 10.1016/j.ijporl.2020.110442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Foreign body (FB) aspiration into the airway is a significant cause of pediatric morbidity and mortality, yet the clinical presentation is diverse and dynamic. There are conflicting recommendations which pre-procedural findings support performing a bronchoscopy, the gold standard for diagnosis and removal of FBs, however a procedure that entails general anesthesia and possible risks. OBJECTIVE Decision whether to proceed to a bronchoscopy may be challenging. Our goal was to enhance decision-making by analyzing the diagnostic values of the different pre-procedural findings in this setting. DATA SOURCES A comprehensive search was performed in PUBMED, EMBASE and Cochrane Review databases to find studies from the last 19 years that reported pre-procedural history, physical examination and radiological findings in patients who had bronchoscopies. STUDY SELECTION Studies were included of pediatric populations if they contained bronchoscopy results (positive and negative for foreign body) with a breakdown according to pre-intervention findings. DATA EXTRACTION AND SYNTHESIS Titles and abstracts retrieved from our search were screened. Thereafter, full-texts were carefully reviewed and selected for inclusion if the aforementioned criteria were met. PRISMA guidelines for systematic review and meta-analyses were followed. MAIN OUTCOME(S) AND MEASURE(S) Cumulative weighted prevalence, sensitivity, specificity, positive and negative predictive values of each pre-procedural finding were calculated, as well as for the "classic triad" (history of an acute event, wheezing, and unilateral decreased breath sounds). Calculation for other combinations of findings, or optimally, constructing a weighted score based on all the findings for each specific patient were not possible to perform, as the specific data breakdown is rarely reported. RESULTS Fifteen studies met inclusion criteria, totaling 5606 patients who underwent bronchoscopies. All studies but one were single center based and all except one were retrospective. No single finding has both positive and negative predictive values over 50%. The "classic triad" has 90% specificity, however only 35% sensitivity. CONCLUSIONS The data is very heterogeneous with regard to pre-procedural findings and how best to guide treatment according to them. This meta-analysis provides cumulative weighted metrics for each finding, to optimize decision-making for the individual patient. Future reporting of data should be enhanced, so that combinations of findings for a specific patient can be used to optimize management. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Gil Zoizner-Agar
- New York University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, New York, NY, USA.
| | - Sabah Merchant
- New York University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, New York, NY, USA.
| | - Binhuan Wang
- New York University School of Medicine, Department of Population Health Division of Biostatistics, New York, NY, USA.
| | - Max M April
- New York University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, New York, NY, USA.
| |
Collapse
|
21
|
Nanda N, Hauser B, Heatley D, Balasubramaniam V, Barreda CB. An unwitnessed case of foreign body aspiration of barium from an unknown source. Int J Pediatr Otorhinolaryngol 2020; 138:110355. [PMID: 33152958 PMCID: PMC7467096 DOI: 10.1016/j.ijporl.2020.110355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 10/24/2022]
Abstract
Foreign body (FB) aspiration is potentially life-threatening in children. A variety of sources and objects have been noted in aspiration events with possible complications ranging from mild to life-threatening. While rare, barium aspiration can cause severe complications, and removal is particularly challenging. Complications of retained barium include acute respiratory distress syndrome, pneumonitis, sepsis, even death. Regardless of the foreign body's identity, substance removal is critical in management. Resourcefulness of removal techniques and an interdisciplinary approach may allow for maximally effective management. We present a case of a pediatric barium aspiration from an unknown source and review evaluation and management strategies.
Collapse
Affiliation(s)
- Nainika Nanda
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA.
| | - Brady Hauser
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - Diane Heatley
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | | | | |
Collapse
|
22
|
Shen J, Huang L, Hao C. Value of multi-slice spiral computed tomography for diagnosis of tracheobronchial foreign body aspiration in children: 5-year retrospective study. Pediatr Int 2020; 62:1184-1188. [PMID: 32348602 DOI: 10.1111/ped.14269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jianqiang Shen
- Department of Pulmonology, Children's Hospital of Soochow University, Suzhou, China.,Department of, Internal Medicine, Children's Hospital of Wujiang District, Suzhou, China.,Department of, Pediatrics, The Ninth People's Hospital of Suzhou, Suzhou, China
| | - Lizhen Huang
- Department of Pulmonology, Children's Hospital of Soochow University, Suzhou, China
| | - Chuangli Hao
- Department of Pulmonology, Children's Hospital of Soochow University, Suzhou, China
| |
Collapse
|
23
|
Lee M, Kim DJ, Jang HB, Lee BJ, Yeom JA, Kim YA, Ko S, Lee IW, Lee JC, Sung ES. Risk factors affecting the treatment outcome of pediatric foreign body aspiration: significance of time factors. Pediatr Surg Int 2020; 36:1061-1066. [PMID: 32676828 DOI: 10.1007/s00383-020-04714-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to identify the factors affecting the prognosis of children with foreign body aspiration (FBA) after undergoing rigid bronchoscopy. METHODS This was a case series with a chart review of 49 children under 3 years of age who underwent rigid bronchoscopy for suspected FBA at a single tertiary institution. RESULTS The time from symptom onset to hospitalization positively correlated with the total hospitalization time (p < 0.001), postoperative hospitalization time (p = 0.006), and operation time (p = 0.013). The time from symptom onset to operation positively correlated with the total hospitalization time (p < 0.001) and operation time (p = 0.046). The time from hospitalization to operation and the operation time positively correlated with the total hospitalization time (p = 0.026, 0.044) and postoperative hospitalization time (p = 0.049, 0.003). The time from symptom onset to hospitalization positively correlated with the incidence of pneumonia (p = 0.028). CONCLUSION Rapid hospitalization after symptom onset, rapid surgery after symptom onset, and rapid surgery after hospitalization improve the prognosis of patients with FBA. Further, a short operation time also plays a role in improving patient prognosis.
Collapse
Affiliation(s)
- Minhyung Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong-Jo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyo-Beom Jang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung-Joo Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Young A Kim
- Department of Pediatrics, College of Medicine, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sunghwa Ko
- Department of Rehabilitation, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Il-Woo Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin-Choon Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Eui-Suk Sung
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| |
Collapse
|
24
|
Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
|
25
|
Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134700. [PMID: 32629891 PMCID: PMC7369691 DOI: 10.3390/ijerph17134700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.
Collapse
|
26
|
Stafler P, Nachalon Y, Stern Y, Leshno M, Mei Zahav M, Prais D, Kadmon G. Validation of a computerized scoring system for foreign body aspiration: An observational study. Pediatr Pulmonol 2020; 55:690-696. [PMID: 31909897 DOI: 10.1002/ppul.24632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/27/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision-making. In the present study, we aimed to validate it on a further cohort. STUDY DESIGN In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re-evaluation and bronchoscopy, if respiratory symptoms persisted. RESULTS Thirty-five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty-five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re-evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively. CONCLUSION The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision-making with regard to the need for bronchoscopy in children presenting to the emergency room.
Collapse
Affiliation(s)
- Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Nachalon
- Ear, Nose, and Throat Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yoram Stern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ear, Nose, and Throat Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Moshe Leshno
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kadmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| |
Collapse
|
27
|
Unusual Bronchial Foreign Bodies with Localized Bronchiectasis in Five Children. Case Rep Med 2020; 2019:4143120. [PMID: 32089700 PMCID: PMC7011307 DOI: 10.1155/2019/4143120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022] Open
Abstract
Obstructive foreign bodies are uncommon causes of bronchiectasis in children, the causal relationship between foreign body aspiration and bronchiectasis remains unclear. We conducted a review of children who were diagnosed with bronchiectasis due to foreign body retention in a university hospital between 2014 and 2019. Five patents were studied (four boys, one girl; age range: 15 months to 13 years old). Computed tomography showed localized cylindrical bronchiectasis in all five patients. After removal of the foreign body by bronchoscopy, the prognoses were good. Patients with localized cylindrical bronchiectasis should be examined to exclude foreign body. As long as foreign body aspiration is diagnosed early and appropriately removed, the possibility of a lobectomy or even mortality is greatly reduced.
Collapse
|
28
|
Chronic Nonasphyxiating Bronchial Foreign Body Removal: Bronchoscopic Debridement With Tracheal Window Extraction. J Bronchology Interv Pulmonol 2020; 26:e34-e37. [PMID: 31233475 DOI: 10.1097/lbr.0000000000000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Chang AB, Redding GJ. Bronchiectasis and Chronic Suppurative Lung Disease. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7161398 DOI: 10.1016/b978-0-323-44887-1.00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Deng B, Tang W, Su F, Li H, Lai W, Xie R, Yan R, Chen Q, Zhou L, Liu S. Application of cystourethroscopy during tracheobronchial foreign body removal in children. J Int Med Res 2018; 46:3741-3747. [PMID: 29882458 PMCID: PMC6135999 DOI: 10.1177/0300060518778477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to describe preliminary experiences associated with removal
of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU). Methods We performed a retrospective analysis of 127 paediatric cases of TFB removal
by CU at our centre from January 2009 to August 2016. Data that were
extracted from the medical records included age, sex, location and nature of
the TFBs, operation time, and complications. Results All TFBs were successfully removed by CU. The mean time of the procedure was
3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal
of TFBs by CU during the initial trial, 19 (14.96%) were successfully
treated in the second trial, and six (4.72%) required a third trial.
Otolaryngologists with 2, 5, and 7 years of professional CU training showed
a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86
minutes, respectively. In the operations, oxygen saturation fell below 90%
at an average occurrence of 0.39 times, but no patients showed a decrease
below 85%. Only one patient experienced laryngeal oedema after the
procedure. Conclusion CU is a useful technique and minimizes complications and operational risks
during removal of paediatric TFBs.
Collapse
Affiliation(s)
- Bifan Deng
- 1 Department of Otolaryngology Head and Neck Surgery, Hezhou City People's Hospital, Hezhou, China
| | - Weiguang Tang
- 1 Department of Otolaryngology Head and Neck Surgery, Hezhou City People's Hospital, Hezhou, China
| | - Feiqun Su
- 2 Department of Nursing, Hezhou City People's Hospital, Hezhou, China
| | - Hua Li
- 3 Department of Pediatrics, Hezhou City People's Hospital, Hezhou, China
| | - Wanqiang Lai
- 1 Department of Otolaryngology Head and Neck Surgery, Hezhou City People's Hospital, Hezhou, China
| | - Ruibin Xie
- 4 Department of Cardiovascular Medicine, Hezhou City People's Hospital, Hezhou, China
| | - Ruqing Yan
- 5 Department of Pharmacy, Hezhou City People's Hospital, Hezhou, China
| | - Qiangwen Chen
- 6 Department of Urology, Hezhou City People's Hospital, Hezhou, China
| | - Lianxing Zhou
- 7 Department of Emergency Medicine, Hezhou City People's Hospital, Hezhou, China
| | - Shaofeng Liu
- 5 Department of Pharmacy, Hezhou City People's Hospital, Hezhou, China
| |
Collapse
|
31
|
Hegde S, Bahadur U, Kanojia RP, Bawa M, Samujh R. Bronchoscopic Airway Foreign Body Extraction without Using Optical Forceps. J Indian Assoc Pediatr Surg 2018; 23:87-89. [PMID: 29681699 PMCID: PMC5898210 DOI: 10.4103/jiaps.jiaps_85_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: Airway foreign body (FB) is a very common pediatric surgical emergency. On certain difficult occasions, the extraction of FB with optical forceps (OFs) is difficult. These conditions create a life-threatening scenario. We present some of the alternative methods of FB extraction for these situations. Patients and Methods: This is a retrospective case review of patients presenting to pediatric emergency with airway FB. All patients had a chest X-ray done before the procedure. Rigid bronchoscopy was performed in all patients for retrieval. Results: A total of 20 patients (6 females) were successfully scoped. The age ranged from 1.5 years to 12 years (mean 3.5 years). Bronchoscopic removal was aided by dormia basket (DB) in 13, Fogarty's catheter (FC) in 6, and magnet aided removal in 1. Complete removal was achieved in all patients. Conclusions: We recommend that DB, FC, and a magnet should form an indispensable part of bronchoscopy set. The use of these alternative methods is successful and allows ventilation during the removal in contrast to removal by OFs. These should be kept as an option if retrieval is difficult.
Collapse
Affiliation(s)
- Shalini Hegde
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Umesh Bahadur
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Prakash Kanojia
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
32
|
A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children. J Otolaryngol Head Neck Surg 2018; 47:26. [PMID: 29636112 PMCID: PMC5894130 DOI: 10.1186/s40463-018-0272-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/27/2018] [Indexed: 01/16/2023] Open
Abstract
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.
Collapse
|
33
|
A Rare Incidental Finding of a Foreign Body in the Nasopharynx during Adenotonsillectomy. Case Rep Otolaryngol 2018; 2018:8361806. [PMID: 29796331 PMCID: PMC5896208 DOI: 10.1155/2018/8361806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
|
34
|
Schurr E, Bogot N, Kuint RC, Erez E, Springer C, Picard E. Bronchial perforation with aortic pseudo-aneurysm due to aspirated foreign body. Pediatr Int 2018; 60:313-315. [PMID: 29436072 DOI: 10.1111/ped.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/07/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Efrat Schurr
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Affiliated with the School of Medicine, Hebrew University, Jerusalem, Israel
| | - Naama Bogot
- Radiology Department, Shaare Zedek Medical Center, Affiliated with the School of Medicine, Hebrew University, Jerusalem, Israel
| | - Ruth Cytter Kuint
- Radiology Department, Shaare Zedek Medical Center, Affiliated with the School of Medicine, Hebrew University, Jerusalem, Israel
| | - Eldad Erez
- Cardio-Vascular Surgery Department, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
| | - Chaim Springer
- Pediatric Pulmonary Unit, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Affiliated with the School of Medicine, Hebrew University, Jerusalem, Israel
| |
Collapse
|
35
|
Donato L, Mai Hong Tran T, Ghori UK, Musani AI. Pediatric Interventional Pulmonology. Clin Chest Med 2018; 39:229-238. [DOI: 10.1016/j.ccm.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
36
|
Kim S, Oh KJ, Kim JH, Sun YH, Lim DH. Clinical characteristics of foreign body aspiration in children in Incheon city, Korea. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.6.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sun Kim
- Department of Pediatrics, Inha University School of Medicine, Suwon, Korea
| | - Kyung Jin Oh
- Department of Pediatrics, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jeong Hee Kim
- Department of Pediatrics, Inha University School of Medicine, Suwon, Korea
- Environmental Health Center for Allergic Diseases, Inha University Hospital, Suwon, Korea
| | - Young Han Sun
- Department of Pediatrics, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University School of Medicine, Suwon, Korea
- Environmental Health Center for Allergic Diseases, Inha University Hospital, Suwon, Korea
| |
Collapse
|
37
|
Reichert F, Amrhein P, Uhlemann F. Unnoticed aspiration of palate plate impression material in a neonate: Diagnosis, therapy, outcome. Pediatr Pulmonol 2017; 52:E58-E60. [PMID: 28440911 DOI: 10.1002/ppul.23710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/31/2017] [Indexed: 11/07/2022]
Abstract
A 7 week old infant was admitted with respiratory failure. Chest X-ray showed an atelectatic right upper lobe, herniation of right middle and lower lobe into the left thorax, and compression-atelectasis of the left lung. Thoracic CT showed complete occlusion of the right superior bronchus with a radiopaque foreign material. Six weeks prior, an impression for a palate plate using polyvinylsiloxane was taken. The material was removed with a rigid endoscopy, in readiness of extracorporeal oxygenation in case of tracheal obstruction or bronchial rupture. After 4 months of follow-up a hyper reactive airway with recurrent upper and lower airway infections remains.
Collapse
Affiliation(s)
- Friedrich Reichert
- Department of Pediatric Cardiology, Intensive Care Medicine, Pulmonology, Allergology, Klinikum Stuttgart, Olgahospital Stuttgart, Stuttgart, Germany
| | - Peter Amrhein
- Department of Otorhinolaryngology, Klinikum Stuttgart, Stuttgart, Germany
| | - Frank Uhlemann
- Department of Pediatric Cardiology, Intensive Care Medicine, Pulmonology, Allergology, Klinikum Stuttgart, Olgahospital Stuttgart, Stuttgart, Germany
| |
Collapse
|
38
|
Gruber M, van Der Meer G, Ling B, Barber C, Mills N, Neeff M, Salkeld L, Mahadevan M. The bacterial species associated with aspirated foreign bodies in children. Auris Nasus Larynx 2017; 45:598-602. [PMID: 28779997 DOI: 10.1016/j.anl.2017.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/04/2017] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Maayan Gruber
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand; Faculty of Medicine, Bar-Ilan University, Israel.
| | - Graeme van Der Meer
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Benjamin Ling
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Colin Barber
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Nikki Mills
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Michel Neeff
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Lesley Salkeld
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| | - Murali Mahadevan
- Paediatric Otolaryngology Unit, Starship Children's Hospital, Auckland, New Zealand
| |
Collapse
|
39
|
A foreign body mimicking tracheal stenosis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:137-138. [PMID: 28747947 PMCID: PMC5519841 DOI: 10.5114/kitp.2017.68746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/13/2017] [Indexed: 11/22/2022]
|
40
|
Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children. Radiol Clin North Am 2017; 55:845-867. [DOI: 10.1016/j.rcl.2017.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
41
|
Taşkınlar H, Bahadır GB, Erdoğan C, Yiğit D, Avlan D, Naycı A. A Diagnostic Dilemma for the Pediatrician: Radiolucent Tracheobronchial Foreign Body. Pediatr Neonatol 2017; 58:264-269. [PMID: 27876259 DOI: 10.1016/j.pedneo.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/20/2015] [Accepted: 07/19/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine the role of clinical history, physical examinations, and radiological findings in the evaluation of patients with suspected radiolucent foreign body aspiration. METHODS The medical records of 236 children (under the age of 18 years), on whom a rigid bronchoscopy was performed between 1999 and 2015 because of suspected radiolucent foreign body aspiration, were analyzed retrospectively. Sensitivity, specificity, positive and negative predictive values of clinical history, physical examinations, and radiological findings were evaluated. RESULTS In 71.1% of all cases, the children were under the age of 3 years. The bronchoscopy showed the presence of a foreign body in 52.9% of cases, with the locations of the foreign bodies being as follows: (1) right main bronchus, 47.2%; (2) left main bronchus, 36.0%; (3) trachea, 11.2%; (4) both bronchi, 5.6%. Organic foreign bodies were found in 78% of the patients, whereas inorganic foreign bodies were detected in 22% of the patients. The sensitivity and specificity of clinical history, physical examinations, and radiological findings were 98.4% and 54.9%, 47.2% and 74.7%, and 35.2% and 92.7%, respectively. CONCLUSION Tracheobronchial foreign body aspirations usually occur prior to the age of 3 years, with the most frequently aspirated foreign bodies being food or items of a radiolucent nature. Clinical history, physical examinations, and radiological findings are not able to detect the presence of a radiolucent foreign body aspiration in children. Therefore, a bronchoscopy should be performed on children in whom a choking event has been witnessed, even in cases of normal radiological and clinical findings.
Collapse
Affiliation(s)
- Hakan Taşkınlar
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| | - Gökhan Berktuğ Bahadır
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| | - Cankat Erdoğan
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| | - Doğakan Yiğit
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| | - Dinçer Avlan
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| | - Ali Naycı
- Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey
| |
Collapse
|
42
|
Foreign body aspiration in children: Focus on the impact of delayed treatment. Int J Pediatr Otorhinolaryngol 2017; 96:111-115. [PMID: 28390598 DOI: 10.1016/j.ijporl.2017.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/20/2022]
Abstract
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.
Collapse
|
43
|
Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Weir K, Grant CC, Irwin RS. Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report. Chest 2017; 151:875-883. [PMID: 28104362 DOI: 10.1016/j.chest.2016.12.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/19/2016] [Accepted: 12/23/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. METHODS We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. RESULTS Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. CONCLUSIONS Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed).
Collapse
Affiliation(s)
- Anne B Chang
- Menzies School of Health Research, Respiratory Department, Lady Cilento Children's Hospital, and Queensland University of Technology, QLD, Australia.
| | - John J Oppenheimer
- New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
| | - Miles M Weinberger
- Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Kelly Weir
- Lady Cilento Children's Hospital, Brisbane, Australia
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | | |
Collapse
|
44
|
Andronikou S, Goussard P, Sorantin E. Computed tomography in children with community-acquired pneumonia. Pediatr Radiol 2017; 47:1431-1440. [PMID: 29043419 PMCID: PMC5608781 DOI: 10.1007/s00247-017-3891-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/27/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
Abstract
Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.
Collapse
Affiliation(s)
- Savvas Andronikou
- Department of Paediatric Radiology, Bristol Royal Hospital for Children and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
- Department of Radiology, University of Cape Town, Cape Town, South Africa.
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Erich Sorantin
- Department of Radiology, Medical University Graz, Graz, Austria
| |
Collapse
|
45
|
Kostic G, Petrovic M, Markovic S, Knezevic J, Igrutinovic Z, Medovic R, Raskovic Z, Stankovic L, Minic P. Application of the Virtual Bronchoscopy in Children with Suspected Aspiration of the Foreign Body - Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In diagnosing the aspiration of the foreign body (AFB) in children most important are: medical history, clinical signs and positive radiography of the lungs. Common dilemmas in the diff erential diagnosis are life-threatening asthma attacks or difficult pneumonia. Conventional rigid bronchoscopy (RB) is not recommended as a routine method. Virtual bronchoscopy (VB) can be a diagnostic tool for solving dilemmas. Fiber-optic bronchoscopy (FOB) has a therapeutic stake in severe cases. Herein, we describe a girl, at the age of 6, who was hospitalized due to rapid bronchoconstriction and based on the anamnesis, clinical symptoms and physical fi ndings the suspicion was that she aspirated the foreign body. Due to the poor general condition and possible sequel, the idea of RB was dropped out. Multidetector computed tomography of the chest and VB was performed and AFB was not found. Due to positive epidemiological situation, virus H1N1 was excluded. FOB established that the foreign body does not exist in the airways. During bronchoscopy numerous castings are aspirated from the peripheral airways which lead to faster final recovery. With additional procedures, the diagnosis of asthma was confirmed and for girl that was the first attack. Along with inhaled corticosteroids as prevention she feels well.
Virtual bronchoscopy can be successfully used as a valid diagnostic procedure in suspected foreign body in the children’s lungs, but fiber-optic bronchoscopy remains most important diagnostic and therapeutic method.
Collapse
Affiliation(s)
- Gordana Kostic
- Clinic for Pediatrics, Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Center for Pulmonary Diseases, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Slavica Markovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jasmina Knezevic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zoran Igrutinovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Rasa Medovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Zorica Raskovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Lidija Stankovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Predrag Minic
- Institute for health protection of mother and child of Serbia “dr Vukan Cupic”, Belgrade, Serbia
| |
Collapse
|
46
|
Martin A, van der Meer G, Blair D, Mahadevan M, Neeff M, Barber C, Mills N, Salkeld L, Gruber M. Long-standing inhaled foreign bodies in children: Characteristics and outcome. Int J Pediatr Otorhinolaryngol 2016; 90:49-53. [PMID: 27729151 DOI: 10.1016/j.ijporl.2016.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Dora Blair
- Starship Children's Hospital, Auckland, New Zealand
| | | | - Michel Neeff
- Starship Children's Hospital, Auckland, New Zealand
| | - Colin Barber
- Starship Children's Hospital, Auckland, New Zealand
| | - Nicola Mills
- Starship Children's Hospital, Auckland, New Zealand
| | | | - Maayan Gruber
- Starship Children's Hospital, Auckland, New Zealand; Otolaryngology Department, Naharia West Galilee Medical Centre, Naharia, Israel.
| |
Collapse
|
47
|
Zhang L, Yin Y, Zhang J, Zhang H. Removal of foreign bodies in children's airways using flexible bronchoscopic CO2 cryotherapy. Pediatr Pulmonol 2016; 51:943-9. [PMID: 26969845 DOI: 10.1002/ppul.23361] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/08/2015] [Accepted: 10/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present retrospective study investigated the safety and efficacy of removing foreign bodies from children's airways using flexible bronchoscopic CO2 cryotherapy instead of traditional foreign body aspiration. METHODS Between October 2012 and June 2014 in the Shanghai Children's Medical Center, we performed flexible bronchoscopic CO2 cryotherapy to remove foreign bodies from the airways of 12 children who ranged in age from 10 to 40 months and analyzed outcomes and complications. RESULTS Using cryotherapy, we successfully and without complications removed the foreign bodies in eight of 12 children. In two cases, the foreign bodies were removed successfully, but cryotherapy partially damaged the airway mucosa, which caused partial airway obstruction because of the newly developed granulation tissue. We incompletely removed the foreign body in one case and failed to remove the foreign body in another case. No serious adverse reactions or complications were observed after the treatments. CONCLUSION Removal of foreign bodies from children's airways using flexible bronchoscopic CO2 cryotherapy may be a safe, easy, and effective method. Pediatr Pulmonol. 2016; 51:943-949. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Yin
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
48
|
Tatsanakanjanakorn W, Suetrong S. Do Times until Treatment for Foreign Body Aspiration Relate to Complications? Int J Otolaryngol 2016; 2016:2831614. [PMID: 27630713 PMCID: PMC5005547 DOI: 10.1155/2016/2831614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/29/2016] [Accepted: 07/27/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. Foreign body aspiration is an emergency condition and may be fatal. Delayed diagnosis and treatment may be associated with complications. This study evaluated the association between time until treatment and complications due to foreign body aspiration. Methods. This study was a retrospective study conducted at Khon Kaen University Hospital, Thailand. We enrolled patients diagnosed with foreign body aspiration with evidence of foreign body detected using direct laryngobronchoscopy at any area from the larynx to the bronchus. Descriptive statistics were used to analyze the association of times of treatment with complications of foreign body aspiration. Results. During the study period, there were 43 patients that met the study criteria. The most common age group was 0-2 years. Plant seeds were the most common foreign bodies (41.9%), and the right main bronchus was the most common site (16 patients, 37.2%). There were 30 patients (69.8%) that experienced complications from foreign body aspiration. Pneumonia was the most common complication (14 patients, 32.6%). The retention time was not significantly associated with the presence of complications (p value: 0.366). Two patients (4.7%) died due to complete airway obstruction and prolonged hypoxia. Conclusion. Times until treatment were not significantly associated with complications from foreign body aspiration.
Collapse
Affiliation(s)
| | - Surapol Suetrong
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|
49
|
Sink JR, Kitsko DJ, Georg MW, Winger DG, Simons JP. Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg 2016; 155:501-7. [DOI: 10.1177/0194599816644410] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
Objectives To examine the sensitivity and specificity of history, physical examination, and radiologic studies as predictors of foreign body aspiration in children. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods Medical records were reviewed for 102 children who presented to our institution from 2006 to 2013 with suspected foreign body aspiration and who underwent endoscopy. Data included symptoms, physical examination, radiologic, and endoscopy findings. Descriptive statistics, sensitivity and specificity, and univariate and multivariable analyses were performed. Results A total of 102 patients were included (62% male). The mean age was 3.3 years (SD, 3.7). A foreign body was identified on endoscopy in 69 cases (68%). The most common presenting symptoms were cough (88%), choking/gagging (67%), and wheezing (57%). Decreased breath sounds and wheezing on examination were independently associated with increased odds of foreign body. The most common abnormal radiographic finding was air trapping (33%). The most frequent items retrieved were fragments of seeds and nuts (49%). There were no serious complications related to endoscopy. The sensitivity and specificity of any finding on history, physical examination, and imaging were 100% and 3%, 90% and 33%, 61% and 77%, respectively. Having a positive history, examination, and chest radiograph combined was 46% sensitive and 79% specific. Conclusions Patients with airway foreign bodies have varied presentations. The presence of any radiologic finding suggests that endoscopy should be performed, as a foreign body is probable. The absence of any history or physical examination finding was associated with a low likelihood of a foreign body.
Collapse
Affiliation(s)
- Jacquelyn R. Sink
- UPMC Medical Education Preliminary Year Residency Program, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania, USA
| | - Dennis J. Kitsko
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew W. Georg
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel G. Winger
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P. Simons
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
50
|
Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016; 51:450-69. [PMID: 26840008 DOI: 10.1002/ppul.23380] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 12/31/2022]
Abstract
Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.
Collapse
Affiliation(s)
- Vikas Goyal
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.,Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Southport, Australia
| | - Julie Marchant
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - I Brent Masters
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, 4101, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Australia.,Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|