Tracheobronchial foreign body aspiration in adults. South Med J. 2009;102:171-174. [PMID: 19139679 DOI: 10.1097/smj.0b013e318193c9c8]

Knowledge attitude and practice towards foreign body aspiration management among kindergarten teachers in south-west Amhara, rural Ethiopia

Background

Aspiration of a foreign body (FB) is the act of unintentionally ingesting food, drink, or typically items. In every country on earth, it is the main cause of death. Aspirations of a foreign body in kids are typically emergency situations and account for a significant part of accidental fatalities. Problems are made worse by a lack of community understanding about foreign body aspiration.

Objective

To assess the level and determinants of knowledge, attitude, and practice towards the first aid management of foreign body aspiration and airway obstruction among kindergarten teachers in northwest Amhara, Ethiopia, 2022.

Methods

An institution-based cross-sectional study was undergone on kindergarten teachers.

Result

The result of this study showed that 78.4% of the participants had good knowledge or scored equal or more than the mean score. The total score of the attitude was calculated by rating the respondent's correct-full responses on the attitude questions; a total of 337 (93.4%) answered all the six questions above the mean level of 5.98, indicating that 93.4% of the respondents have a positive attitude.

Discussion

In the present study, 78.4% of kindergarten teachers demonstrated good knowledge. In contrast, a study conducted in Addis Ababa, and Ethiopia, revealed that only 37% of participants exhibited good knowledge regarding foreign body aspiration management, significantly lower than the current study's findings. Additionally, the same study found that 93% of kindergarten teachers held a positive attitude toward foreign body aspiration management, aligning with the results of a cross-sectional study in Addis Ababa, and Ethiopia, where the attitude score was 95.1%.

Conclusion and recommendation

The result of this research shows that majority participants of this study have good knowledge and attitude towards foreign body aspiration management, but poor practice about it.

Tracheobronchial Foreign Body Aspiration: Spontaneous Expectoration After Beta-2 Agonist Administration

Tracheobronchial foreign body (TFB) aspiration in adults is uncommon but can be life-threatening, often due to differences in airway sizes and reflexes. Symptoms associated with TFB are typically choking episodes followed by cough and dyspnea, but sometimes it can lead to acute asphyxiation. Chest radiography and computed tomography can provide information about the foreign body, its characteristics, and its location, however, bronchoscopy remains the preferred method for diagnosis and removal. In this case report, we describe an instance of hijab pin aspiration where the patient expectorated the foreign body immediately following the administration of inhaled salbutamol.

Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study

AIM

To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge.

METHODS

We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review.

RESULTS

We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively.

CONCLUSIONS

Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.

A Large Board Pin in the Right Main Bronchus: A Case Report With Review of Literature

Foreign body (FB) aspiration is one of the most common emergency scenarios in cardiothoracic surgery and ENT unit consultations. We present the case of a 16-year-old male student who inadvertently ingested board pins while enjoying leftover savory. Despite the initial shock, he promptly sought evaluation at the local primary care facility. Remarkably, he remained largely asymptomatic. A subsequent chest radiograph revealed a radiopaque FB lodged in the right main bronchus. Employing a rigid bronchoscope, we successfully extracted the FB, obviating the need for open surgical intervention. What sets this case apart is the unusual combination of a large FB aspiration with minimal symptoms and the absence of internal injury during retrieval.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report

Although aspiration of a foreign body into the trachea and bronchi can occur in all age groups, it is more common in infants and young children. Foreign bodies in the tracheobronchial tree are uncommon in adults and mainly present in patients with dysphagia and an altered level of consciousness. The identification of foreign bodies in the tracheobronchial tree is frequently overlooked or delayed, leading patients to present later with chronic symptoms and potential complications. These complications may include persistent coughing, wheezing, obstructive pneumonitis, bronchiectasis, and abscess formation secondary to recurrent pulmonary infections. This article aims to present the case of a 27-year-old patient without risk factors for aspiration who has experienced recurrent self-limiting hemoptysis episodes for five years. Bronchoscopy revealed a foreign body at the entrance to the middle lobe bronchus. The presence of a foreign body in the tracheobronchial tree should be considered in any patient with recurrent hemoptysis. Bronchoscopy leads to accurate diagnosis, treatment, and prevention of complications.

Obstructive pneumonia with bronchial foreign body: A case report

The age of predilection for foreign body aspiration into the lower airway shows a bimodal distribution, with the majority of cases occurring in children or infants and in the elderly. Although several pediatric airway foreign bodies have been summarized, in adults, bronchial foreign bodies are relatively uncommon. There are a variety of symptoms induced by airway foreign bodies, although the typical symptoms of some bronchial foreign bodies are cough. Bronchial foreign bodies, especially in the elderly, may have few symptoms and it is necessary for careful identification. Therefore, it is very important to carefully perform medical consultations about current and past medical history. Herein, we report a case of an elderly Japanese with obstructive pneumonia with a bronchial foreign body of fish bone with a long history of cough. It is known that people in some countries such as Japan have a habit of eating fish. Therefore, it is necessary to more carefully explore the possibility of some bronchial foreign body such as a fish bone, when we observe symptoms of persistent cough in such countries.

A Case of Migratory Foreign Body in Left Bronchus -Scarf Pin

Tracheobronchial foreign body aspiration is a life threatening emergency which requires immediate medical attention. Foreign body aspiration caused by sharp objects like scarf pins was more common in young girls, possibly due to casual handling of sharp objects. Most of the patients were symptomatic with cough and choking episodes. The penetration and dislodgement was the most commonly reported symptom in the majority of the patients. Here we are presenting a case of a young female with accidental swallowing of sharp scarf, following which she developed throat pain and cough. A detailed radiological examination was performed which showed that a foreign body had migrated into the left bronchus, which was removed with a bronchoscope. This case demonstrates the emergency management of a sharp foreign object that was inhaled into the airway.

Foreign Body Aspiration Mimicking an Endobronchial Neoplasm: A Case Report and Review of the Literature

Foreign body aspiration (FBA) is infrequently encountered in the adult population, with major risk factors including advancing age, intoxication, and disorders of the central nervous system. Here, we present a case of FBA in an adult undergoing routine lung cancer screening to review imaging findings and highlight potential pitfalls for the practicing radiologist. A low-dose chest computed tomography (CT) scan was performed for lung cancer screening in a 57-year-old male with a one-month history of worsening dyspnea and cough. An endobronchial lesion was identified in the right bronchus intermedius. A follow-up 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) revealed hypermetabolic activity in the region of interest, raising concern for malignancy. Bronchoscopy was performed, revealing a nodular mass adjacent to a foreign body in the bronchus intermedius. Histopathologic analysis of the tissue sample revealed the presence of an aspirated foreign body with squamous metaplasia of the respiratory epithelium. Adult FBA is an uncommon clinical entity that may be incidentally observed on a screening chest CT. Relevant multimodality imaging findings are discussed here, along with a review of the accompanying pathologic changes seen with chronic airway impaction.

A case of an occult bronchial foreign body in the right upper lung of an adult.. [DOI: 10.21203/rs.3.rs-2276172/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Bronchial foreign bodies (BFBs) are less common in adults. An occult bronchial foreign body (OBFB) is a BFB with nontypical history, symptoms, physical signs and imaging, and is prone to either a delayed diagnosis, a missed diagnosis, or a misdiagnosis. There are no reported cases of adult OBFBs present in the upper lobe of the right lung alone. Case Description A 57-year-old previously healthy woman with no history of foreign body aspiration presented with recurrent cough and sputum that was present from August 2021 to May 2022. Her chest computed tomography (CT) suggested pneumonia in the upper lobe of the right lung, and tuberculosis had to be ruled out. After the laboratory tests to exclude tuberculosis were performed, she was diagnosed with pneumonia of the upper lobe of the right lung. Her symptoms were still recurrent after anti-infection and expectorant treatment. Finally, a yellowish-white substance (curd-like or cottage cheese-like) was found in the upper lobe of the right lung under flexible bronchoscopy, and the patient's cough and sputum symptoms were significantly relieved after removal of the substance. Conclusions OBFBs in adults are clinically rare and are prone to either a delayed diagnosis, a missed diagnosis or a misdiagnosis. A patient can be suspected of having a BFB after meeting the 4 conditions of OBFB and having any one indicator—risk factors, indirect signs of lesions on CT, or recurrent respiratory symptoms after treatment. Flexible bronchoscopy is necessary, and rigid bronchoscopy and surgery can be alternate means.

Risk factors associated with radiolucent foreign body inhalation in adults: a 10-year retrospective cohort study

BACKGROUND

Foreign body aspiration (FBA) is a serious condition with high morbidity and mortality rates. Although chest radiography is generally the first radiologic modality used in diagnosis, a substantial percentage of foreign bodies are radiolucent in adults with diagnosis challenging.

METHODS

Retrospective review of adult patients with FBA diagnosed by flexible electronic bronchoscopy from 2012 to 2022 collecting demographics, history, hospital presentation, radiographic, and operative details. Risk factors associated with radiolucent foreign body inhalation in adults were explored using appropriate statistical methods.

RESULTS

Between 1 January 2012 and 1 January 2022, 114 adult patients diagnosed with FBA were enrolled. The median age of participants was 65 years (IQR 52-74). Multidetector computed tomography (MDCT) examinations identified 28 cases (25%) showing direct visualization of the foreign body (defined as the radiopaque group) and 86 cases (75%) in the radiolucent group. Multivariable stepwise linear regression analysis showed increased odds of radiolucent foreign body inhalation in adults associated with pneumonic patches in MDCT (OR 6.99; 95% CI 1.80-27.22; P = 0.005) and plants/meat foreign bodies (OR 6.17; 95% CI 1.12-33.96; P = 0.04). A witnessed choking history (OR 0.02; 95% CI 0-0.14; P < 0.001) was a protective factor of radiolucent foreign body inhalation in adults.

CONCLUSIONS

Unlike radiopaque FBA, in those presenting with a suspected radiolucent foreign body aspiration, the diagnosis is far more challenging. Risk factors such as lacking a choking history, non-resolving pneumonia (pneumonic patches) in MDCT findings, and plants/meat foreign bodies may help in the early diagnosis of radiolucent foreign body inhalation in adults. Further prospective multicenter studies should be conducted to validate the findings.

Acute-onset Breathlessness: An Unexpected Etiology?

Acute-onset breathlessness has multifactorial causes where early spotting of etiology assists in prompt treatment of these cases. Other than usual causes, an often-neglected cause, especially in adults, is non-asphyxiating foreign body aspiration. Here, we describe a case of a 40-year-old male who had aspirated an organic foreign body under alcohol intoxication and presented with symptoms of acute-onset breathlessness and severe hypoxia. Prompt diagnosis and bronchoscopy-guided removal result in a quick recovery of symptoms in the index patient.

Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study

Background

This retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments.

Methods

Accidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified.

Results

There were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components.

Conclusion

The incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

Removal of a foreign body by rigid bronchoscope after virtual reality-aided presurgical planning: A case report

Flexible bronchoscopy is becoming increasingly important for the removal of airway foreign bodies. However, in cases of risk of coughing during the procedure, rigid bronchoscopic intervention should be performed under general anesthesia. A 22-year-old man presented with history of several episodes of fever, for which he was administered antibiotics at a private clinic. In an annual chest X-ray and chest computed tomography examination, a foreign body, which appeared to be an orthodontic appliance, was discovered in the left main bronchus. It was deemed difficult to remove the foreign body using flexible bronchoscopy because of granulation tissue formation. Therefore, the patient was referred to our institution. We simulated the clinical situation using virtual reality, which indicated that the proximal and distal metallic parts of the appliance had grown into the bronchial mucosa. First, we inserted a rigid bronchoscope under general anesthesia and cut the granulation tissue using an insulation-tipped diathermic knife. Thereafter, we removed the appliance with grasping forceps under rigid bronchoscope guidance. In cases of risk of foreign body encroachment into the bronchial mucosa or granulation tissue development, rigid bronchoscopic intervention is effective. Furthermore, a VR-based intervention may be a useful option in such cases.

•

Virtual reality provides depth perception and spatial understanding for planning.

•

A rigid bronchoscope can remove foreign bodies better than a flexible one.

•

Cutting tracheal mucosa by an IT knife may be required in some cases.

Sliced Lotus Root as a Hypopharyngeal Foreign Body

Pharyngeal foreign bodies are medical emergencies that require airway protection. Rapid diagnosis and adequate treatment are needed. However, in elderly patients with dementia, diagnosing foreign body aspiration sometimes seems difficult only from the medical history, so we should maintain a high degree of suspicion when treating patients with unexplained symptoms. We herein present a 95-year-old woman with hypersalivation and sore throat two hours after dinner. Due to her mild dementia, sufficient medical history could not be obtained. She could walk and talk, but could not swallow. Her vital signs were all within normal limits. There were no abnormal findings in the oral cavity. The neck x-ray images revealed the patent airway and foreign body in the hypopharynx. We used Macintosh laryngoscope and Magill forceps to remove the foreign body, which was a sliced lotus root with a diameter of 61 mm. After removal, she could swallow, and her symptoms rapidly improved. We should suspect this if the patient presents unexplained pharyngeal symptoms.

Foreign body removal using flexible bronchoscopy in terminal cancer: A case report

RATIONALE

Pulmonary foreign body aspiration is a serious medical problem. The risk of foreign body aspiration into the airways increases considerably in patients with end stage cancer with reduced consciousness and impaired airway reflexes. However, few studies have reported on foreign body aspiration in the airways in patients with terminal cancer or receiving end-of-life care. Herein, we report the use of flexible bronchoscopy in patients with end-of-life cancer with pulmonary aspiration.

PATIENT CONCERNS

A 71-year-old man with neuroendocrine carcinoma was admitted to a palliative care unit for end-of-life care. He accidentally aspirated implant teeth into the airway with decreased consciousness and death rattle.

DIAGNOSIS

On chest x-ray, the foreign material was observed in the left main bronchus.

INTERVENTIONS

Despite concerns regarding the use of bronchoscopy given the deterioration of the overall organ function, flexible bronchoscopy was performed.

OUTCOMES

Eventually, the foreign body was removed using a basket in the nasal cavity without major complications. The patient died comfortably after 7 days.

LESSONS

The possibility of patients in the palliative care unit with reduced consciousness and death rattle to aspirate foreign bodies into the airways must be carefully considered. Flexible bronchoscopy should be considered to carefully remove aspirated foreign bodies in the airway without any side effects, even in patients with terminal cancer or receiving end-of-life care.

Bronchial Foreign Body Aspiration Due to Polycarbophil Calcium

Polycarbophil calcium (Polyful^®; Mylan, Tokyo, Japan) is a stool stabilizer that absorbs liquid and swells to form a soft, bulky mass. A 75-year-old woman experienced sore throat and difficulty breathing immediately after taking the drug. Chest computed tomography showed a foreign body in the right intermediate bronchus. Bronchoscopy showed a white mass blocking the right intermediate bronchus. Since the mass was very fragile, we performed suctioning while breaking up the mass with a suction tube. The mass consisted of polycarbophil calcium. Since aspirated polycarbophil calcium swells and can obstruct bronchi, complete removal is crucial.

The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration

Introduction and importance

Foreign body aspiration (FBA) in adults may be asymptomatic or symptomatic. Fever and cough are the most common symptoms of Coronavirus infection and other causes of pneumonia. Regardless of the etiology of pneumonia, the first step in the treatment of FBA-associated pneumonia is to remove the foreign body from the airway.

Case presentation

A 32-year-old man was referred to our emergency department on October 26, 2020 with shortness of breath (SOB) and a cough. He was referred to the medical center with clinical suspicion of Coronavirus disease-19 (COVID-19), and his disease was treated considering COVID-19. Based on the persistence of his symptoms after discharge, he was referred to the hospital again, and the presence of a foreign body was confirmed by a rigid bronchoscopy, which was then removed.

Clinical discussion

Our patient did not remember any history of aspirating solid particles, choking, or any other high-risk conditions associated with aspiration. Also, he had no symptoms with the exception of cough and SOB before the first admission. It means that asymptomatic FBA can be tolerated and go undiagnosed, particularly in adults, and manifests as a secondary complication, such as pneumonia.

Conclusion

The FBA and other causal agents may mimic COVID-19 pneumonia. Consequently, FBA should be included in the COVID-19 differential diagnosis.

•

The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration.

•

FBA and other causal agents may mimic COVID-19 pneumonia. Consequently, FBA should be included in the COVID-19 differential diagnosis.

•

The taking comprehensive history, physical examination and purposeful paraclinical assessments helps to make the best decision for management of the patients.

A 68-year-old man with haemoptysis and extensive ipsilateral lung infiltrates

A 68-year-old male presented to the emergency department with a 24-h history of haemoptysis and fever. The patient also reported a productive cough for 5 years. He was a current smoker (smoking history of 80 pack-years) with an otherwise unremarkable past medical history. On examination, his respiratory rate was 24 breaths per min, heart rate was 120 beats per min, temperature 39.2°C and his oxyhaemoglobin saturation was 98% in room air. On auscultation, breath sounds were reduced and end-expiratory crackles were heard over the left lung. Physical examination was otherwise normal. Blood tests showed: white blood cells 14 500 cells·μL⁻¹ (neutrophils 12 000 cells·μL⁻¹, lymphocytes 1900 cells·μL⁻¹), haemoglobin 13.9 g·dL⁻¹, platelets 256 000 μL⁻¹, C-reactive protein (CRP) 128 mg·L⁻¹, erythrocyte sedimentation rate 90 mm·h⁻¹, normal electrolytes, urea 45 mg·dL⁻¹ and creatinine 1.22 mg·dL⁻¹.

Can you diagnose this 68-year-old male with 24-h history of haemoptysis, 5-year history of productive cough and ipsilateral lung infiltrates?https://bit.ly/3tyhANB

An Unusual Complication of Electronic Cigarette Use: Missed Inhaled Foreign Body Causing Acute Respiratory Failure

We present a case of a young woman who was admitted to the hospital with persistent pneumonia and cough productive of purulent green sputum. She was admitted to the intensive care unit due to type 1 respiratory failure. Chest computerised tomography (CT) showed a large right-sided hydropneumothorax, for which a right-sided chest drain was inserted. Despite intubation, oxygenation continued to deteriorate and the patient was commenced on veno-venous extracorporeal membrane oxygenation (ECMO) and transferred to the regional ECMO centre. Bronchoscopy revealed a plastic coil from an electronic cigarette at the entrance to the right lower lobe. Following its removal, the patient’s condition rapidly improved and she was successfully weaned from ECMO and discharged from the cardiothoracic critical care unit. There are very few reports of tracheobronchial foreign body (FB) aspiration secondary to electronic cigarette use, and tracheobronchial FB aspiration in adults requiring veno-venous ECMO to treat respiratory failure is uncommon. This case highlights the importance of considering tracheobronchial FB aspiration as a potential diagnosis in patients who present with more than two weeks of pneumonia not responding to treatment.

Aspiration of the dental crown in an elderly patient

The aspiration of objects and foreign bodies requires quick and systematic care. During emergent orotracheal intubation, accidental dental crown release can cause a threat to the patient's life. This paper aimed to report a case of foreign body (dental prosthetic crown) aspiration and its management and discuss alternative approaches. An 81-year-old male patient, who was admitted to the hospital's intensive care unit (ICU) for meningitis, presented with altered consciousness, and decreased oxygen saturation. He underwent emergent orotracheal intubation. After intubation, chest radiography was performed to check for proper orotracheal tube positioning and lung expansion. The resultant images revealed the presence of a foreign body within the right lower lobe bronchus in the shape of a dental crown. The foreign body, intubation cannula and basket clamp were successfully removed, followed by reintubation of the patient. The foreign body was a prosthetic upper premolar dental crown (24). While care should be taken to avoid complications, if a foreign body is aspirated during emergent orotracheal intubation, endoscopic removal appears safe and effective. Careful creation, placement, maintenance, and preservation of prosthetic crowns are critically important in elderly patients.

Endobronchial use of gastrointestinal retrieval net for an aspirated dental crown

Introduction/aim

Flexible fiberoptic bronchoscopy is generally the first line procedure for airway foreign body removal. However, removal may be challenging when surface and/or other characteristics make grasping the object difficult. We present a case in which we used a gastrointestinal retrieval net to successfully extract a dental crown, a type of foreign body with difficult-to-grasp surface characteristics.

Methods

A 72-year-old male aspirated a dental crown during an attempted molar crown fitting. Semi-emergent flexible fiberoptic bronchoscopy was undertaken using an Olympus bronchoscope with a 2.8mm working channel. Attempts at retrieval using standard forceps, and a four-wire airway retrieval basket were unsuccessful. The retrieval net (RescueNet, Boston Scientific) is a device used in gastrointestinal procedures to retrieve foreign objects, food boluses and tissue fragments. The device's external catheter is 2.5mm in diameter and is passed through the working channel of an endoscope. The handle operates in a similar manner to conventional biopsy forceps and deploys a one-sided fishnet mesh basket with an adjustable string collar that can be manipulated to enclose a target.

Results

The dental crown was easily removed with the retrieval net on the second attempt. Upon review of the literature, endobronchial usage of retrieval nets was found to be rare.

Conclusion

Clinicians should be aware that gastrointestinal retrieval nets are an option for the retrieval of airway foreign bodies.

[Pleuro-pneumopathy revealing an unusual inhaled bronchial foreign body]

Inhalation of foreign bodies is not often observed in young adults, and may go unnoticed. A 37-year-old patient, with no significant medical history, was admitted for right basal pleuro-pneumopathy. Endoscopic examination revealed the presence of a brittle yellowish formation. It was a bone fragment, accidentally inhaled by the patient. It is necessary to look for an inhaled foreign body in cases of serious infection unusually observed in an immuno-competent patient.

Large Aerodigestive Tract Foreign Body Extraction Complicated by End-Stage Dementia

A foreign body in the upper aerodigestive tract can be life-threatening. It is especially challenging for surgeons and anesthesiologists working in a limited shared workspace. A case is presented of an 83-year-old woman with end-stage dementia afflicted with oral fixation as defined as overeating or putting objects in the mouth other than food. She appeared asymptomatic although she had altered baseline mentation and was found to have ingested a large foreign object. This case provides an opportunity to discuss the unique challenges of performing anesthesia on patients undergoing the extraction of a large upper aerodigestive tract foreign body, complicated by end-stage dementia.

Role of bronchoscopy and imaging in long-standing foreign body bronchus presenting as recurrent or non-resolving lower respiratory tract infection

INTRODUCTION

A long-standing retained foreign body in the bronchus is unusual. In majority of cases, an adequate history is not obtained, the clinical picture is usually clouded by superadded pathological changes.

CASE SERIES

We report three cases of long-standing foreign body in the airway who presented with recurrent lower respiratory tract infection. Examination of respiratory system revealed no significant abnormality. Chest radiograph was normal. CT scan of the chest was useful to indicate endobronchial opacity in the airway suggestive of a foreign body. The patients underwent rigid bronchoscopy under general anesthesia for successful removal of the foreign body.

CONCLUSION

So the patients with non-resolving or recurrent lower respiratory symptoms in spite of medical treatment and without any obstructive findings must undergo diagnostic bronchoscopy evaluation and imaging.

Extraordinary Delayed-Onset Negative Pressure Pulmonary Hemorrhage Resulting in Cardiac Arrest after General Anesthesia for Vocal Cord Polypectomy

Negative pressure pulmonary edema and hemorrhage are uncommon but potentially life-threatening complications associated with general anesthesia. Postoperative negative pressure pulmonary edema usually occurs immediately after surgery, and delayed-onset cases occurring more than 1 hour after surgery have rarely been reported. A 37-year-old woman with bronchial asthma underwent vocal cord polypectomy under general anesthesia in another hospital and experienced cardiac arrest due to a negative pressure pulmonary hemorrhage occurring 3 hours and 30 minutes after surgery. She was successfully treated with venoarterial extracorporeal membrane oxygenation and completely recovered without any complications. Extraordinary delayed-onset negative pressure pulmonary hemorrhage occurring more than three hours after surgery has rarely been reported. This case may indicate the need for more careful observation of patients following surgery.

A melting, encapsulated, calcified pulmonary nodule in a healthy 51-year-old woman: a case report

Background

Foreign body aspiration is less common in healthy adults, which makes diagnosis difficult. Early detection of smaller/sharp foreign bodies in the distal airway is more difficult because patients might have no symptoms and imaging studies could appear normal.

Here we describe the course of a small, sharp foreign body (chicken bone) lodged in the distal airway of a healthy middle-aged woman. The chicken bone was initially thought to be an old calcified tuberculoma. However, it was encased in a dilated bronchus without obvious surrounding lymphadenitis or parenchymal infiltration, and it melted with time. Two years later, histopathological examination revealed that the calcified lesion was an aspirated chicken bone with a concomitant tuberculoma.

Case presentation

A 51-year-old woman showed an old calcified tuberculoma in the upper right lung lobe during routine examinations. It was “encased” in a dilated bronchus, although it was not raised from the surrounding lung parenchyma. The size of the calcified part decreased (“melted”) with time, and the surrounding inflammation progressed 2 years later, a phenomenon never described in association with tuberculosis. Bronchoscopy revealed a fragment of chicken bone lodged in the next two branches of the upper right posterior bronchus. Surgical segmentectomy was performed, and histopathological examination revealed that the calcified lesion was formed by a fragment of chicken bone as well as a tuberculoma. Eventually, the patient recalled an episode of choking on a chicken bone 5 years ago; she believed that she had coughed it out completely at that time.

Conclusions

The “melting” and “encased” phenomena observed in the present case could be useful imaging findings for early detection of small foreign body aspiration in the distal airway.

Airway Stenosis Related to Foreign Body Aspiration: An Under-recognized Long term Complication

Introduction:

Sequelae of chronic foreign body aspiration include occlusive granulation tissue formation, which can cause delayed fixed airway stenosis. The aim of this study is to highlight this complication, which should be diagnosed early and treated proactively.

Methods:

We present a case series of areca nut aspiration, an organic foreign body commonly chewed in Southeast Asia, complicated by delayed airway stenosis and examine the peculiar nature of areca nut that predisposes to this complication.

Results:

Long-term sequelae of areca nut aspiration are granulation tissue formation, potentially complicated by airway stenosis due to the mechanical and chemical irritant nature of areca nut.

Discussion:

Organic impacted foreign bodies such as areca nut can cause delayed complications of airway stenosis. Both the sharp edges of the areca nut and chemical irritation caused by alkaloids released by the nut in constant contact with the airway mucosa can predispose to this long-term complication. Early diagnosis and appropriate therapeutic interventions such as balloon bronchoplasty can help restore airway patency and prevent lung damage.

Risk factors for lower respiratory tract infection in children with tracheobronchial foreign body aspiration

The aim of this study was to determine the risk factors for lower respiratory tract infection (LRTI) in children caused by tracheobronchial foreign body aspiration (TFBA).A total of 351 patients were retrospectively reviewed; all patients were diagnosed with TFBA at West China Hospital of Sichuan University from 2015 to 2017. Univariate analyses and multivariate analysis were used.Age (<2 years) (P < .001), type of foreign body (plant) (P < .001), shape of foreign body (nonsmooth) (P < .001), and residence time of foreign body (>7 days) (P = .001) were risk factors for LRTI on univariate analysis. Multivariate analysis showed age (<2 years) (hazard ratio [HR] = 4.457; 95% confidence interval [CI] = 2.031-6.884; P < .001), type of foreign body (plant) (HR = 2.686; 95% CI = 1.577-3.452; P < .001), shape of foreign body (nonsmooth) (HR = 1.649; 95% CI = 1.437-3.663; P < .008), and residence time of foreign body (>7 days) (HR = 1.751; 95% CI = 1.329-3.554; P = .004) were independent risk factors for LRTI. Furthermore, children with LRTI also had longer lengths of hospital stays and antibiotic use than did children without LRTI.Age, plant foreign body, nonsmooth foreign body, and long-term incarceration were all independent risk factors for LRTI in children. These results can help us to select more appropriate intervention times and stratified treatment for children with TFBA.

Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice

Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.

Metallic hair pin aspiration into the left tertiary bronchus

Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.

Sphingomonas paucimobilis empyema caused by remote foreign body aspiration

Empyema secondary to foreign body aspiration is rare in adults. We present a case of empyema in a 77-year-old male patient related to a remote aspiration event during a dental procedure. A CT of the chest and bronchoscopy confirmed that a metallic foreign body was located within the right lower lobe bronchus. His pleural fluid culture revealed Sphingomonas paucimobilis which is a low-virulent opportunistic gram-negative bacilli and rarely causes infection. The patient received meropenem followed by levofloxacin and recovered uneventfully. The attempt of foreign body removal was failed due to chronic inflammation, and the patient refused further surgical management.

Validation of the Choking Risk Assessment and Pneumonia Risk Assessment for adults with Intellectual and Developmental Disability (IDD)

BACKGROUND

Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia.

AIM

To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD.

METHODS

Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions.

RESULTS

The CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001).

CONCLUSIONS

The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.

[When the denture becomes dangerous!]

Bien que rare chez l'adulte, l'inhalation de corps étranger (CE) est un accident grave pouvant mettre en jeu le pronostic vital ou entrainer des séquelles importantes. Nous rapportons l'observation d'un patient de 50 ans, sans antécédents pathologiques particuliers, qui s'est présentée aux urgences pour douleur thoracique, toux intermittente et dyspnée d'effort, six jours après avoir inhalé, accidentellement, sa prothèse dentaire en plastique lors d'un repas. L'examen clinique était sans particularités. La radiographie thoracique ainsi que l'ASP ne montraient pas d'anomalie. Une bronchoscopie souple sous anesthésie générale a permis de visualiser le CE au niveau du tronc intermédiaire et l'extraction a été réalisée avec succès évitant ainsi le recours à un geste beaucoup plus invasif. La radiographie standard peut s'avérer utile en visualisant les CE radio-opaque ou par des signes indirects évoquant la présence d'un CE, mais le recours à la bronchoscopie à visée diagnostique et thérapeutique est primordial.

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.

An unusual case of chronic cough: Professional liability in dentistry?

Foreign body aspiration (FBA) is a serious medical problem, also in dental practice. The case report describes the case of a patient who for 12 years has suffered from chronic cough as a result of the aspiration of a polymeric silicone resin fragment during a dental procedure. In November 2002, the patient was underwent dental care, and she points out that, when performing dental imprint, she had sensed that something “went down in the throat” but she was immediately reassured by the dentist. After lung CT was performed, the foreign body was identified and removed with benefit to the patient. The knowledge of this case report could be useful for dentists who perform dental impressions, to be aware of the fact that the material used is radiolucent e.g. cannot be seen on plan radiographs and it can be accidentally inhaled by the patient. The knowledge of the case is also important for doctors who come in contact with patients who previously underwent dental treatment, suffering from persistent cough, in the absence of positive radiological signs.

Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker

Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male. RB is generally the preferred approach for extraction of a large complex FB; however, due to its size, the FB had to be removed using FLXB combined with an endobronchial blocker. In this report, we describe the anesthetic and surgical considerations and the novel technique used to extract the FB.

A rare case of bilateral bronchial foreign body

We present the case of a 7-year-old male patient with bilateral bronchial cocklebur fruit aspiration, which he sustained while playing. The patient presented with a triad of cough, wheezing, and decreased breath sounds (decreased in the right lung and absent in the left). These symptoms led to a diagnosis of bilateral bronchial foreign body, which was confirmed by computed tomography three-dimensional reconstruction of the bronchial tree. The patient was on the verge of death during operation but was ultimately rescued. Our therapeutic experience in treating this case of bilateral bronchial cocklebur fruit aspiration may provide a good reference for others.

Airway foreign body aspiration: common, yet easily overlooked! Two interesting cases

Two cases: A 66-year-old woman was referred to the hospital due to dyspnoea and cough. Seven months prior to referral, the patient had choked on a chunk of nut and grain-filled bread. She had daily cough and dyspnoea. The patient was convinced of an airway foreign body and she contacted her general practitioner and the emergency service several times; they all found this unlikely. Fibre optic bronchoscopy revealed two obstructing nut-like foreign bodies in the right upper and lower lobe, respectively. A 77-year-old man with sarcoidosis developed increased dyspnoea and sputum production. Three weeks earlier, the patient had choked on a magnesium tablet. Everyone was convinced that the tablet had dissolved. Infection was suspected. Chest CT scan was performed showing no obvious signs of infection or progression in sarcoidosis. After the CT scan, the patient coughed up the remains of the tablet and his symptoms resolved. Retrospective evaluation of the CT scan revealed the tablet.

Aspiration-related pulmonary syndromes

Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.