Thoracic foreign bodies in adults

The extraordinary journey of a metal endoclip to the outside of the chest wall

Metal endoclips are frequently utilized in surgical procedures. Within the medical literature, metal endoclip migration following general surgical procedures is a widely studied complication. However, examples of thoracic metal endoclip migration are, as yet, absent in the medical literature. This case study seeks to provide the first clear example of such thoracic metal endoclip migration.

Missed Foreign Body and Necessitans Empyema

A recurrent empyema over a three-month period ultimately presented as an empyema necessitans (an empyema pointing through the skin) due to Fusobacterium varium. The recurrence of the empyema was due to an animal vertebra aspirated, during a bar-room altercation, into the right main bronchus, mimicking an endobronchial tumour.

Foreign Bodies of the Ear, Nose and Throat

Foreign bodies to the ear, nose, and throat often can be managed in the emergency department, particularly if the patient offers a history consistent with foreign body and is calm and compliant with the examination and removal attempts. Tips for success include analgesia, adequate visualization, immobilization of the patient's head, dexterity and experience level of the provider, and minimizing attempts at removal. It is critical to recognize the risks involved with certain retained objects (button batteries or sharp objects) and when to call a consultant to help facilitate safe, successful removal of objects to the ear, nose, and throat.

Foreign body aspiration in adult airways: therapeutic approach

Tracheobronchial foreign body (FB) aspiration is an uncommon but potentially life-threatening event in adults. Symptoms typically consist of a choking event followed by cough and dyspnea, however, these findings are inconsistent and symptoms may mimic more chronic lung diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can provide information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. The authors describe the typical clinical presentation, diagnostic evaluation, and bronchoscopic management of foreign bodies in adult airways with a focus on bronchoscopic techniques and potential complications of FB extraction.

Tracheobronchial foreign body aspiration in adults

Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increase with advancing age. Risk factors for TFB aspiration in adults are a depressed mental status or impairment in the swallowing reflex. Symptoms associated with TFB aspiration may range from acute asphyxiation with or without complete airway obstruction, to cough, dyspnea, choking, or fever. In adults, many other medical conditions mimic breathing abnormalities similar to those associated with TFB aspiration. If the history is not suggestive, then only a high index of suspicion can ensure proper diagnosis and timely removal of the foreign body. Initial treatment is airway support. Radiographic imaging may assist in localizing the foreign body. Bronchoscopic removal of the foreign body is necessary to avoid long-term sequelae. Flexible bronchoscopy is effective both in the diagnosis and removal of foreign bodies.

Not the typical winter cough

We report on a young adult with a foreign body lodged in the right main bronchus for at least 5 days, with no alleged recollection of aspiration despite the size and shape of the object, which was removed successfully by rigid bronchoscopy.

Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration

OBJECTIVE

The purpose of this study was to investigate the potential use of low-tube-current MDCT virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration.

SUBJECTS AND METHODS

Low-tube-current MDCT was performed in 23 patients (10 girls, 13 boys) with a mean age of 3.3 years (9 months-13 years) with suspicion of foreign body aspiration. Chest radiographs were obtained before CT was performed. MDCT was performed using 25- to 50-mA tube currents. MDCT virtual bronchoscopy images were obtained. Neither sedation nor IV contrast medium was used during CT scanning. All patients underwent endoscopic evaluation within 24 hr after MDCT was performed. MDCT virtual bronchoscopy findings were retrospectively compared with the results of rigid bronchoscopy.

RESULTS

The mean tube current was 35 mA (range, 25-50 mA). Imaging quality was excellent in nine studies (39%), good in 12 studies (52%), and poor in two studies (9%). Motion artifacts were present on several slices in five examinations. In 15 patients, all foreign bodies detected by conventional bronchoscopy were also revealed on MDCT virtual bronchoscopy. The foreign body was in the right main bronchus in six patients, in the bronchus intermedius in one patient, and in the left main bronchus in eight patients. No discordance was found between the two techniques. MDCT revealed hyperaeration of the ipsilateral lung in five patients, atelectasis in five patients, infiltration in three patients, and infiltration and bronchiectasis in two patients; it showed infiltration in four patients and atelectasis in one of eight patients without a foreign body detected. There were no abnormal findings in three patients.

CONCLUSION

Evaluation of foreign body aspiration of the airway in children can be accomplished by using a low-tube-current MDCT protocol. It may be useful both in showing the exact location of a foreign body before bronchoscopy and in ruling out a foreign body in patients with a low level of suspicion and normal or nonspecific findings on chest radiography.

Foreign bodies in the chest: how come they are seen in adults?

The radiologic and clinical findings of foreign bodies in the chest of children are well recognized. Foreign bodies in adults are infrequent, however, and the radiologic findings of these unusual circumstances have rarely been described. We classified various thoracic foreign bodies into three types according to their cause: Type I, Aspiration, Type II, Trauma or Accident; Type III, Iatrogenic. This pictorial essay will illustrate the radiologic findings and consequences of thoracic foreign bodies in adults, which have rarely been described in the radiologic literature. The clinical significance of thoracic foreign bodies will be also be discussed.