Airway Foreign Bodies in Adults:

Saviour tool now a foreign body

ABSTRACT

Foreign bodies are commonly seen in children, here presenting a case of a male adult with an impacted thumb pin in the left lower lobe bronchus. Extraction required fiber-optic bronchoscopy, failure of which led to thoracotomy with bronchotomy.

Foreign Body Retrieval by Using Flexible Cryoprobe in Children

BACKGROUND

Foreign body aspiration (FBA) can be a life-threatening emergency and the cause of significant morbidity and mortality in children. Although rigid bronchoscopy is considered as the treatment of choice for the retrieval of foreign bodies (FBs) among pediatrics, extraction with the flexible fiberoptic bronchoscope (FFB) has become increased in popularity over the last few years. Recently, though there have been some reports about the use of cryoprobes as tools for the removal of FBs in adults, there is a limited experience concerning pediatrics, especially during the infancy period. The aim of this study is to describe the characteristics of FBs and cryoextraction as the new method of treatment.

METHODS

This retrospective study was conducted on 50 pediatric patients with FBA who were managed by using the flexible cryoprobes to evaluate their outcomes between September 2013 and October 2018.

RESULTS

A total of 50 children ranging in age from 7 months to 15 years underwent cryoextraction for the airway FBA retrieval with FFB using a cryoprobe. The main symptoms patients complained of were choking, cyanosis, cough, and noisy breathing. History, clinical examination, and finally radiologic examination were the diagnostic tools. The treatment consisted of FFB using cryoprobes under slight general anesthesia with maintaining the patient's spontaneous breathing. Using cryoextraction turned to be very useful.

CONCLUSION

Using cryoextraction can be a reliable and preferred method with minimal complications for extracting airway FBs among children, especially those that have a friable texture.

A complicated cockroach-ectomy

The exact incidence of foreign body aspiration among adults is unknown, and its clinical presentation is vastly divergent. We report the previously undescribed occurrence of cockroach aspiration in an adult, presenting with a “crawling sensation” in his chest. Flexible endobronchial examination revealed a foreign body impacted in the lingula, resembling the Australian cockroach Periplaneta australasiae. Partial extraction via biopsy forceps was performed and complicated by acute hypoxia on disimpaction, requiring a brief period of bag/mask ventilation. Following the offset of procedural sedation, the remaining foreign body was manually expectorated. A total of 24 h post‐procedure, the patient was febrile with positive blood cultures (Micrococcus luteus). We highlight the importance of definitive airway support during endobronchial interventions and raise the question regarding the significance of transient bacteraemia following bronchoscopic manipulation.

Airway foreign bodies: A critical review for a common pediatric emergency

BACKGROUND

Airway foreign bodies (AFBs) is an interdisciplinary area between emergency medicine, pediatrics and otolaryngology. It is a life-threatening condition that is not infrequently seen; however, it is poorly covered in medical literature. Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years, predominantly males. Moreover, it is the leading cause of infantile deaths and the fourth one among preschool children.

DATA RESOURCES

A systemic search was conducted in July 2015 using PubMed/PubMed Central Database of The National Center for Biotechnology Information (NCBI) (http://www.ncbi.nlm.nih.gov/). A total of 1 767 articles were identified and most of them were meta-analyses, systematic reviews, and case series. Those thoroughly discussing assessment and management of AFBs were retrieved.

RESULTS

AFBs episodes may be either witnessed or missed. Presence of a witness for the inhalation is diagnostic. The later usually present with persistent active cough. A classical triad of paroxysmal cough, wheezing, and dyspnoea/decreased air entry was reported, though many presentations have inconsistent findings. Hence, diagnosis requires high index of clinical suspicion. Flexible fibro-optic bronchoscopy is the gold standard of diagnosis, whereas inhaled objects are best retrieved by rigid bronchoscopes.

CONCLUSIONS

Close supervision of pediatrics is the hallmark of prevention. Caregivers should ensure a safe surrounding milieu, including the toys their offspring play with. Immediate complications result from direct obstruction or injury by the inhaled object. Alternatively, prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia, respectively.

Aerodigestive foreign bodies in adult ethiopian patients: a prospective study at tikur anbessa hospital, ethiopia

Introduction. Foreign bodies (FBs) in the aerodigestive tract are important causes of morbidity and mortality and pose diagnostic and therapeutic challenges. The best method of removal of an esophageal and tracheobronchial FB is endoscopic guided extraction. Objective. To present our experience of the removal of aerodigestive FBs in adult Ethiopian patients using rigid endoscopes. Methods. A hospital-based prospective study, at Tikur Anbessa Referral and Teaching Hospital, from January 2011 to December 2012 (over two years). Results. A total of 32 patients (18 males and 14 females) with a mean age of 28.0 ± 12.74 years were treated for FB ingestion and aspiration at Tikur Anbessa Hospital. The FBs were impacted at the esophagus in 18 (56.2%) patients, at the pharynx in 7 (21.8%), and at the air way in 7 (21.8%) patients. Pieces of bones were the commonest objects found in the esophagus (17/18 of the cases) and the pharynx (4/7), while fractured tracheostomy tubes and needles were frequently seen in the air way (3/7 cases each). The foreign bodies were visible in plain radiographs of 26 (81.2%) patients. Successful extraction of FBs was achieved by using Mc gill forceps in 11 cases, rigid esophagoscopes in 9 patients, and bronchoscopes in 4 cases. Four cases required open surgery to remove the foreign bodies. Two complications (one pneumothorax and one esophageal perforation) occurred. All patients were discharged cured. Discussion and Recommendations. Aerodigestive FBs are not so rare in the hospital and timely diagnosis and removal of accidentally ingested and aspirated foreign body should be performed so as to avoid the potentially lethal complications associated. Rigid esophagoscopy requires general anesthesia and is associated with its own complications, but our experience and outcome of its use are encouraging.

Fractured tracheostomy tube obturator: A rare cause of respiratory distress in a tracheostomized patient

Foreign body aspiration is a worldwide health problem which often results in life threatening complications. Tracheostomy tube fracture resulting in airway obstruction is a serious condition which has been reported in the medical literature. We report a rare case of a tracheostomy obturator fractured and lodged in tracheobronchial tree in a patient who presented with acute respiratory distress. Rigid or flexible bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during a diagnostic examination with a fiberoptic bronchoscope under lignocaine local infiltration with sedation, which may help to avoid any further invasive procedures. Flexible bronchoscopy should always be considered in foreign body aspiration. A periodic review of the techniques of tracheostomy care, including timely check-ups for signs of wear and tear, can possibly eliminate such avoidable late complications.

[Foreign bodies in ENT medicine]

A foreign body (Latin: corpus alienum) is any object originating outside the body. Of all specialties, otolaryngology covers the greatest number of natural body orifices, making foreign bodies a common diagnosis. Foreign bodies of the ear canal and nose often occur in children and are easily accessible during physical examination. Foreign bodies of the oral cavity and oropharynx are also easily removed. Esophageal and tracheobronchial foreign bodies are common in children and the elderly. A number of rigid and flexible endoscopic techniques are available for foreign body removal. In Germany, flexible endoscopy is six times more common than rigid endoscopy. Both methods are highly effective, and each has its advantages in certain situations. Rigid endoscopy is still a key in otolaryngology and can be used in case of failure of flexible techniques. It is therefore important for otolaryngologists to be proficient in both techniques.

A tree grows in bronchus

A tracheobronchial foreign body (TFB) can be a life-threatening emergency that requires urgent intervention. TFBs occur most commonly in childhood as a result of aspiration. Traumatic TFB is not frequently reported in the literature. All reported cases of traumatic TFB to date have involved a projectile mechanism of injury. We report a case of a patient who presented with recurrent pneumonia. Flexible bronchoscopy revealed a TFB partially obstructing the right bronchus intermedius. Pathology confirmed the TFB to consist of wood. Further history revealed that the patient experienced an impaling injury on a tree sucker more than 30 years before presentation. Surgery was required to remove the TFB. This case illustrates the importance of the patient's history, and is the first reported case of an impaling injury causing a traumatic TFB.

Prevalence of flexible bronchoscopic removal of foreign bodies in the advanced elderly

OBJECTIVES

to define the likelihood and establish the overall safety and effectiveness of flexible bronchoscopy in the removal of foreign bodies in the advanced elderly compared to those younger.

DESIGN

a retrospective case-control analysis.

SETTING

tertiary care academic hospital.

POPULATION

7,089 adults (age >18 years), including 949 (15%) advanced elderly (age >75 years), who underwent flexible bronchoscopy between January 1995 and June 2007.

MEASUREMENTS

in those patients with foreign body aspiration (FBA) (n = 20), a comparison of multiple clinical characteristics based on defined age groups (group 1, age <75 years and group 2, age >75 years) was performed.

RESULTS

FBA requiring bronchoscopic removal was greater than three and a half times more likely in patients aged >75 years compared to those younger (OR 3.78, CI 1.4-10: P <0.05). Flexible bronchoscopy was 87.5% effective in the removal of foreign bodies in the advanced elderly and associated with no increase in adverse events.

CONCLUSION

bronchoscopic removal of foreign bodies is more likely in the advanced elderly when compared to those younger. This implies that this population may be most at risk. Flexible bronchoscopy is a safe and effective initial diagnostic and therapeutic approach in this age group.

Extraction of airway foreign bodies in adults: experience from 1987-2008

To determine the incidence and the clinical, radiographic, and endoscopic characteristics of adult patients in our area diagnosed with tracheobronchial foreign bodies (FBs), we have performed a descriptive retrospective study analysing rigid and flexible bronchoscopies practised at our department between 1987 and 2008 in patients older than 14 years. Of the 9781 bronchoscopies performed, 32 involved cases of bronchoaspiration of FBs. The mean age of the patients was 43.81 years (S.D. 21.43); 65.6% were male and 34.4% were female. Acute or recurrent infection was the most frequent clinical presentation. Chest radiographs provided data for diagnosis in 68% of the cases. The most common FB aspirated were inorganic (pins and plastic devices 21.4%, respectively). In conclusion, we can state that in our area tracheobronchial aspiration of FBs by adults is not common. The clinical symptoms are highly variable and the FBs are usually lodged in the right bronchial tree.

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.

Rigid tracheobronchoscopy in the management of airway foreign bodies: 10 years experience in Kosovo

OBJECTIVES

To review the incidence of tracheobronchial foreign body aspiration in the population of Kosovo and to evaluate the clinical features and management of tracheobronchial foreign body aspiration during a 10-year period.

SETTING

Tertiary medical institution, ENT/Head and Neck Surgery Clinic, University Clinical Center, Prishtina, Kosovo.

METHODS

We retrospectively reviewed the medical records of patients with tracheobronchial foreign body aspiration who underwent rigid tracheobronchoscopy between January 1994 and December 2003.

RESULTS

During a 10-year period, 244 rigid tracheobronchoscopy procedures were performed when foreign body aspiration was suspected. In 182 patients (75%), a foreign body was found and extirpated. Of these, 107 (59%) were male and 75 (41%) were female; 124 patients (68%) were aged 0-3 years and 36 (20%) were aged 4-7 years. The most commonly extirpated foreign bodies were peanuts (30% of cases) followed by beans (22.5%) and corn kernels (9%). Of 176 plain chest radiographs, 65% showed no signs of foreign bodies. Two patients (1.1%) died as result of complications related to foreign body aspiration.

CONCLUSION

Rigid bronchoscopy represents a safe and effective tool in the management of foreign body aspiration. However, the high percentage of false-negative results on chest radiography in our series warrants further investigation.

Uncommon causes of cough: ACCP evidence-based clinical practice guidelines

OBJECTIVES

To describe the uncommon causes of cough.

DESIGN/METHODOLOGY

An English language literature search by MEDLINE citations from 1975 through 2004 was used to identify publications on uncommon pulmonary and nonpulmonary disorders in which cough was present as the major or presenting symptom in >50% of those persons affected by the uncommon diseases.

RESULTS

A substantial number of uncommon or rare pulmonary and nonpulmonary disorders were identified. The uncommon occurrence of these diseases made it difficult to develop a meaningful evidence-based guideline to the diagnosis and therapy of many of the uncommon causes of cough. As cough was the major or presenting symptom, it was usually initially attributed to common respiratory diseases (eg, asthma or bronchitis). As a result, a substantial time lag existed from the onset of cough to the diagnosis of the etiologic entity. Diagnostic tests limited to the respiratory system did not always provide clues to the diagnosis of uncommon causes of cough.

CONCLUSIONS

Cough is the major or presenting symptom in many uncommon pulmonary and nonpulmonary disorders. A strong index of suspicion is essential to consider and diagnose the uncommon causes of cough. The diagnosis and management of cough in patients with uncommon causes of cough is dependent on the underlying etiology.