1
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Sarubbi D, Sarubbi A, Strumia A, Pascarella G, Crucitti P, Longo F, Frasca L, Martuscelli M, Tomaselli E, Carassiti M, Agrò FE. I-gel® as airways management in a challenging adult tracheobronchial foreign body aspiration. Indian J Thorac Cardiovasc Surg 2024; 40:473-475. [PMID: 38919200 PMCID: PMC11194225 DOI: 10.1007/s12055-023-01676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 06/27/2024] Open
Abstract
Tracheobronchial foreign body (TFB) aspiration is an uncommon but potentially life-threatening event. This case report discusses the successful extraction of a metallic screw aspirated by a 48-year-old woman with intellectual disability, using flexible bronchoscopy through the i-gel® laryngeal mask under general anesthesia. The i-gel® device proved effective in maintaining airway access and facilitating bronchoscopy, emphasizing its utility in challenging cases. The report underscores the significance of careful assessment, skillful intervention, and multidisciplinary teamwork in managing TFB aspirations, especially in uncooperative patients with comorbidities.
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Affiliation(s)
- Domenico Sarubbi
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Antonio Sarubbi
- Master’s Degree Program in Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy
- Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Alessandro Strumia
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
- Research Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy
| | - Giuseppe Pascarella
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Pierfilippo Crucitti
- Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Filippo Longo
- Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Luca Frasca
- Thoracic Surgery Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Matteo Martuscelli
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Eleonora Tomaselli
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Massimiliano Carassiti
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
- Research Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy
| | - Felice Eugenio Agrò
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
- Research Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy
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2
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Kaushal M, Mahant TS, Mandal A, Sandhu N, Iqbal Z, Brar R. Saviour tool now a foreign body. Lung India 2024; 41:135-138. [PMID: 38700408 PMCID: PMC10959307 DOI: 10.4103/lungindia.lungindia_450_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 05/05/2024] Open
Abstract
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.
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Affiliation(s)
- Mohit Kaushal
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
| | - T. S. Mahant
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
| | - Amit Mandal
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
| | - Navreet Sandhu
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
| | - Zafar Iqbal
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
| | - Rahat Brar
- Department of Pulmonary Medicine, Fortis Hospital, Mohali, Punjab, India
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3
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Tanaka H, Anno T, Takenouchi H, Koyama K, Kaneto H, Okimoto N, Tomoda K. Obstructive pneumonia with bronchial foreign body: A case report. Heliyon 2023; 9:e21362. [PMID: 37920515 PMCID: PMC10618766 DOI: 10.1016/j.heliyon.2023.e21362] [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] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
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.
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Affiliation(s)
- Hitomi Tanaka
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Haruka Takenouchi
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Katsumasa Koyama
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, 701-0192, Japan
| | - Niro Okimoto
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, 700-8505, Japan
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4
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Wu KA, Hsiao CJ, Lee CC, Su TH, Kao YH, Wu GC. Extraction of large foreign bodies from the airway by gastrointestinal endoscopy. Respir Med Case Rep 2023; 45:101907. [PMID: 37635732 PMCID: PMC10448197 DOI: 10.1016/j.rmcr.2023.101907] [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: 09/02/2022] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Foreign body aspiration is a worldwide health problem that often results in life-threatening complications. Although flexible bronchoscopy is a safe procedure for removal of foreign bodies, it is usually unsuccessful in removing large foreign bodies from the airway. Gastrointestinal (GI) endoscopy, which is frequently used to remove foreign bodies from the gastrointestinal tract, has not been reported for retrieval of airway foreign bodies. In this report, we described three successful cases of removal of large airway foreign bodies by GI endoscopy. To avoid rigid bronchoscopy, GI endoscopy can be considered if flexible bronchoscopy has failed to remove a large or heavy airway foreign body in adult patients.
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Affiliation(s)
- Kuo-An Wu
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Life Sciences, National Central University, Jhongli, Taoyuan, 32001, Taiwan
| | - Chia-Jen Hsiao
- Division of Gastroenterology, New Taipei City Hospital, Taiwan
| | - Chu-Ching Lee
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ting-Hsuan Su
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Jhongli, Taoyuan, 32001, Taiwan
| | - Geng-Chin Wu
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
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5
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Zakynthinos GE, Mpaggeas A, Deskata K, Doudakmanis C, Makris D. Flexible Bronchoscopy Combined With an Airway Maneuver for Foreign Material Removal Under Invasive Mechanical Ventilation. Cureus 2023; 15:e44239. [PMID: 37772228 PMCID: PMC10523186 DOI: 10.7759/cureus.44239] [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: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
We present a case of a patient who had aspirated a massive amount of food, leading to cardiac arrest, and had to be intubated because of severe hypoxemia. The hypoxemia persisted, regardless of the recruitment maneuvers, performance of flexible bronchoscopy, and suctioning through the ventilating tube, because we were unable to reach the left main bronchus (LMB), where the greatest amount was concentrated. However, we managed to overcome this problem by using a prototype handling technique to catheterize the LMB directly with the usage of the flexible bronchoscope. We introduce this handling technique for the removal of foreign material from the LMB, which will probably be really useful in emergency situations, because of its simplicity and effectiveness.
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Affiliation(s)
| | | | - Konstantina Deskata
- Department of Critical Care, University General Hospital of Larissa, Larissa, GRC
| | | | - Demosthenes Makris
- Department of Critical Care, General University Hospital of Larissa, Larissa, GRC
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6
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S. P, RB NN, K. G, SR K, S. R. Difficult Bronchoscopy and Foreign Body Removal: Our Experience. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1764365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background Foreign body in the airway is the most life-threatening situation. Most foreign bodies present as acute emergency and can be removed by endoscopy/bronchoscopy, while a few causes complication of a retained foreign body which requires emergency tracheostomy to secure airway followed by foreign body removal.
Case Presentation We report our experience in the management of three children who required tracheostomy through which bronchoscope was introduced and foreign body removed. All patients with unrecognized retained foreign body presented with respiratory distress with desaturation. Imaging was suggestive of atelectasis. After foreign body removal patients recovered well and decannulated by day 5.Subglottis is the narrowest part of pediatric airway. As these foreign bodies were vegetative they are hygroscopic in nature and hence would not be able to remove the foreign body by bronchoscopic guidance. Hence, tracheostomy was done to provide access followed by bronchoscopic removal.
Conclusion Aspirated foreign body present challenges to the ear, nose, and throat surgeon. Newer techniques enable removal of foreign body easier. Tracheostomy combined with bronchoscopy can be a life-saving and easy to perform procedure which involves removal of foreign body at the same time.
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Affiliation(s)
- Prabakaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Namasivaya Navin RB
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Gowthame K.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Karthika SR
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Rajasekaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
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7
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Yuan M, Xiao Y, Ni F, Yin W, Hu Y. Endobronchial removal of the peripherally located foreign body with the ultrathin bronchoscopy and ultrathin cryoprobe guided by a manual navigating method: A case report. Medicine (Baltimore) 2022; 101:e31903. [PMID: 36482649 PMCID: PMC9726376 DOI: 10.1097/md.0000000000031903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONAL The bronchoscope is a preferential method used to remove airway foreign bodies, but for those located in the distal lumen of bronchus with long-time retention, how to remove them remains an intractable problem. PATIENT CONCERNS A 57-year-old male presented with 2-week history of intermittent hemoptysis. Chest CT upon admission revealed a high-density opacity incarcerated in the distal basal segment of the left lower lobe, along with obstructive pneumonia. DIAGNOSES The patient was diagnosed as foreign body aspiration. INTERVENTIONS We firstly used a manual navigating method to draw a bronchoscopic map according to the thin-section CT. Then we adopted ultrathin bronchoscope (UTB) to remove the peripherally located foreign body. OUTCOMES UTB successfully found the foreign body incarcerated in LB10ciiβ under the guidance of manual navigation, but it was too tender to be extracted completely by forceps, and it was even pushed further away. Then 1.1 mm ultrathin cryoprobe was used, with an activation time of 4 seconds, the chili was frozen and completely removed. LESSONS This first combined application of manual navigating method, UTB and ultrathin cryoprobe, successfully extracted foreign bodies lodged in the distal airways and thus avoided thoracic surgery.
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Affiliation(s)
- Mingli Yuan
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Xiao
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Ni
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Yin
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Hu
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yi Hu, Department of Respiratory Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Street, Jiang’an, Wuhan 430014, China (e-mail: )
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8
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Huang X, Qiu J, Zhang Z, Lin S, Song M, Zheng Y. 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] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
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.
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Affiliation(s)
- Xiaoqing Huang
- Second Affiliated Hospital of Shantou University Medical College
| | - Jinfeng Qiu
- Second Affiliated Hospital of Shantou University Medical College
| | - Zhihuan Zhang
- Second Affiliated Hospital of Shantou University Medical College
| | - Sujuan Lin
- Second Affiliated Hospital of Shantou University Medical College
| | - Mei Song
- Second Affiliated Hospital of Shantou University Medical College
| | - Yongyuan Zheng
- Second Affiliated Hospital of Shantou University Medical College
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9
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KENÇ S, IŞIK G, GÜNBAY T, KAHRAMAN S, ÇELİK F. Implant screwdriver aspiration during dental procedure at a geriatric patient: a case report. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1086254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Caldeira JN, Fernandes L, Sousa SR, Martins Y, Barata F. Flexible bronchoscopy as the first-line strategy for extraction of tracheobronchial foreign bodies. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37496589 PMCID: PMC10369595 DOI: 10.1016/j.opresp.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Huh JY. Foreign body aspirations in dental clinics: a narrative review. J Dent Anesth Pain Med 2022; 22:161-174. [PMID: 35693357 PMCID: PMC9171332 DOI: 10.17245/jdapm.2022.22.3.161] [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] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Foreign body aspiration can produce a medical emergency. Obstruction of the airways can be life-threatening, and complications may develop in less-severe cases if it is left untreated. Although it is more prevalent in children by approximately three times, adults can still experience it, and it is more frequently related to healthcare in adults. Objects used in dental treatment are usually placed in the oral cavity and can be ingested or inhaled by accident. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. However, few reports have been published on dentistry-related foreign body aspiration. This paper discusses the disease course, management, and clinical outcomes of foreign body aspiration, especially those associated with dentistry. The patient must be examined for respiratory distress. If the patient is unstable, urgent airway management and the maneuvers for removal should be performed. Radiographs and computed tomography can help identify and locate the object. The treatment of choice is often bronchoscopy, and both flexible and rigid endoscopes can be used depending on the situation. Preventive measures need to be implemented to avoid inhalation accidents given the potential consequences. Though the incidence is rare, healthcare levels need to be enhanced to avert morbidity and mortality. Radiological evaluation and bronchoscopy are vital for management.
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Affiliation(s)
- Jin-Young Huh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Gwang-Myeong, Republic of Korea
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12
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Li XY, Hou HJ, Dai B, Tan W, Zhao HW. Adult with mass burnt lime aspiration: A case report and literature review. World J Clin Cases 2021; 9:9935-9941. [PMID: 34877333 PMCID: PMC8610930 DOI: 10.12998/wjcc.v9.i32.9935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Foreign body aspiration mainly occurs in children, which can cause a severe concurrent syndrome and even death without timely treatment. As a rare foreign body, aspiration of lime is seldom reported, and most cases involve a small amount of hydrated lime. Although the symptoms are usually severe, the prognosis is good after suitable treatment. Experience of treatment for lime aspiration is lacking, and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.
CASE SUMMARY We report an adult with a large amount of burnt lime aspiration. Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital, he suffered several severe complications, including complete occlusion of the right primary bronchus, aeropleura, aerodermectasia, pneumomediastinum, secondary infection and hypoxemia at 4 d after injury. After transferring to our department, bronchoscopy was immediately carried out to clear the lime in the major airway, using foreign body forceps, biopsy forceps, puncture needle, and hairbrush. The patient’s condition recovered rapidly and at 3-months’ follow-up, he demonstrated good recovery of the bronchus and lung parenchyma.
CONCLUSION After mass lime aspiration, flexible fiberoptic bronchoscopy is suggested as early as possible, using clamping, flushing or cryotherapy.
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Affiliation(s)
- Xin-Yu Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hai-Jia Hou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Hong-Wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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13
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Hamada N, Tanaka S. A Novel Type of Aspiration Presenting With Acute Respiratory Failure Caused by Upper Airway Obstruction Due to Diaper Pica. Cureus 2021; 13:e16375. [PMID: 34408930 PMCID: PMC8362874 DOI: 10.7759/cureus.16375] [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] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
We herein report an extremely rare case of acute respiratory failure due to pica of the high-molecular-weight polymers in a diaper (HMWPD). An 81-year-old woman was admitted to our hospital because of dyspnea. Several hours earlier, the facility staff saw her tearing the diaper and eating it. And several hours later, the staff found her complaining of dyspnea. Her chest computed tomography revealed airway foreign bodies. Immediately, flexible bronchoscopy was performed. The trachea and the bilateral bronchi were filled with the HMWPD. We tried to grasp the HMWPD with various common instruments, but the HMWPD could not be grasped. Finally, we performed direct bronchoscopic suction. All the HMWPD were removed successfully. The HMWPD have hygroscopic property resulting in volume expansion and the fatal consequence of upper airway obstruction. Physicians working in an emergency department should be aware of this acute respiratory failure due to diaper pica and its effective treatment.
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Affiliation(s)
- Noboru Hamada
- Respiratory Medicine, Okayama City Hospital, Okayama, JPN
| | - Suzuka Tanaka
- Respiratory Medicine, National Hospital Organization Okayama Medical Center, Okayama, JPN
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14
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Arida AK, Khaddam O, Al Naher S, Elghul A. A Rare Case of a Massive Food Bolus Mimicking Lung Cancer. Cureus 2020; 12:e11043. [PMID: 33101789 PMCID: PMC7575316 DOI: 10.7759/cureus.11043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tracheobronchial aspiration is a very common and serious medical condition. It can present acutely with an aspiration pneumonia, or it can be chronic and occur over a long period of time. In some instances, the diagnosis can be missed, and patients may be treated for years for other medical conditions such as asthma, with no significant improvement. We present here a very interesting case of a 69-year-old gentleman with multiple comorbidities who presented with a fever and shortness of breath. He was initially diagnosed with aspiration pneumonia, but when he did not improve, a bronchoscopy was performed, which showed a mass in the right bronchus suspicious for a carcinoid tumor. However, a biopsy was taken and sent to pathology for analysis, which showed food material. He underwent a rigid bronchoscopy for mass removal, which indeed confirmed that the whole mass was composed of food material as a result of tracheobronchial aspiration.
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Affiliation(s)
| | - Omar Khaddam
- Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Sarah Al Naher
- Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Ashraf Elghul
- Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
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15
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Callaham S, Kelly A, Stevens L, Thomas D, Carr MM. A Case of Pediatric Aspiration of a Metallic Spring. Cureus 2020; 12:e9987. [PMID: 32983687 PMCID: PMC7511068 DOI: 10.7759/cureus.9987] [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: 12/03/2022] Open
Abstract
Prolonged retention of a foreign body after aspiration can lead to numerous respiratory complications. We present a case in which an unwitnessed aspiration of a metal spring by a child led to several months of unilateral wheezing and subsequent physical changes in his left mainstem bronchus. The prompt removal of an airway foreign body requires a high index of suspicion by the physician in order to facilitate proper workup to confirm the diagnosis, allow for prompt management, and minimize damage to the airway.
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Affiliation(s)
- Sarah Callaham
- Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, USA
| | - Andrew Kelly
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, USA
| | - Levi Stevens
- Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, USA
| | - David Thomas
- Pediatrics, West Virginia University School of Medicine, Morgantown, USA
| | - Michele M Carr
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, USA
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Utility of Flexible Bronchoscopy for Airway Foreign Bodies Removal in Adults. J Clin Med 2020; 9:jcm9051409. [PMID: 32397612 PMCID: PMC7290307 DOI: 10.3390/jcm9051409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/16/2022] Open
Abstract
Foreign body aspiration is relatively infrequent in adults. Airway foreign bodies (AFBs) can be removed by flexible bronchoscopy (FB) or rigid bronchoscopy (RB). We performed a retrospective analysis of FBs performed in our centre over a 25 year period, focusing on the procedures that revealed an AFB during the examination stage. We recorded demographic data, clinical characteristics and radiological and bronchoscopic findings. During the study period, 12,588 FBs were performed in adults. Airway foreign bodies were identified in 32 of these cases, giving a prevalence of 0.25%. The most frequent clinical presentation was cough, sputum and fever. The most frequent radiological findings were alveolar infiltrates and atelectasis. In 94% of cases, AFBs were removed successfully by FB; RB was necessary in only 6% of cases. There were no FB-related complications. The most common AFB location was the right bronchial tree (69%). We classified AFBs as organic (85%: animal 57%; vegetable 28%), inorganic (6%) and iatrogenic (9%). Bronchial infection occurred in 51% of cases, and Actinomyces spp. was the most common causal microorganism. In conclusion, AFBs are a rare entity with nonspecific clinical presentation, most AFBs were organic, and FB is a safe and effective method for AFB removal.
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Flexible Bronchoscopy Combined with Rigid Bronchoscopy for Treatment of Scarring in the Bronchus Caused by a Foreign Body. Case Rep Med 2019; 2019:4616298. [PMID: 31316565 PMCID: PMC6604489 DOI: 10.1155/2019/4616298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
Foreign body (FB) aspiration into the tracheobronchial tree is an emergency in the pediatric department, particularly in children aged <3 years. FB granulation tissue is commonly found in children with FB aspiration. However, scarring in the bronchus caused by a FB is rare. We herein report a case involving aspiration of a plastic whistle toy with scarring in the bronchus. The scar tissue was successfully removed by interventional bronchoscopy combined with a flexible electrosurgery probe and carbon dioxide cryotherapy.
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Successful Removal of a Chronic Aspirated Foreign Body after Twelve Years. Case Rep Pulmonol 2018; 2018:8241591. [PMID: 29955410 PMCID: PMC6000843 DOI: 10.1155/2018/8241591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022] Open
Abstract
Chronic retention of aspirated foreign bodies is rare but can result in indolent systemic and respiratory symptoms. Bronchoscopy may show features of tissue reaction to the foreign body, including granulation tissue, endobronchial stenosis, strictures, edema, and airway distortion. The diagnosis of foreign body aspiration is often difficult to establish since some patients may not give a clear history of aspiration or may present late. In addition, patients may be misdiagnosed with chronic pneumonia, bronchitis, asthma, or malignancy. We present the case of a 42-year-old male who had a chronically retained piece of an aluminum beverage container in the left mainstem bronchus for 12 years. Careful history, radiographic evaluation, and bronchoscopic examination revealed the foreign body, which was successfully extracted by rigid bronchoscopy.
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Costa C, Feijó S, Monteiro P, Martins L, Gonçalves JR. Role of bronchoscopy in foreign body aspiration management in adults: A seven year retrospective study. Pulmonology 2018; 24:S2173-5115(17)30182-3. [PMID: 29331544 DOI: 10.1016/j.rppnen.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- C Costa
- Chest Department, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal.
| | - S Feijó
- Respiratory Endoscopy Unit, Chest Department, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal; Pulmonology Department, Cento Hospitalar de Leiria, R. de Santo André, 2410-197 Leiria, Portugal
| | - P Monteiro
- Respiratory Endoscopy Unit, Chest Department, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - L Martins
- Chest Department, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - J Rosal Gonçalves
- Respiratory Endoscopy Unit, Chest Department, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
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20
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Hata A, Nakajima T, Ohashi K, Inage T, Tanaka K, Sakairi Y, Wada H, Fujiwara T, Suzuki H, Iwata T, Yoshino I. Mini grasping basket forceps for endobronchial foreign body removal in pediatric patients. Pediatr Int 2017; 59:1200-1204. [PMID: 28763138 DOI: 10.1111/ped.13384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/12/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Appropriate device selection is crucial for endobronchial foreign body removal using a bronchoscope. In pediatric patients, bronchoscopy requires the use of a thin device due to the narrow access to the airway, limiting the range of useful endobronchial devices. We herein review our experience in endobronchial foreign body removal with a focus on the type of bronchoscope and the instruments used in comparison with the literature, and investigate the utility of mini grasping basket forceps (FG-55D, Olympus® ; and Zero Tip™ , Airway Retrieval Basket, Boston Scientific). METHODS Between April 2008 and April 2016, foreign bodies were removed from the airway of 12 pediatric patients by bronchoscopy. These cases are reviewed in this study. The clinical presentation, location and characteristics of the foreign bodies, and the type of bronchoscope and instruments used were analyzed. RESULTS A consecutive series of 12 pediatric patients was retrospectively reviewed, and the therapeutic characteristics investigated. Nuts were the most frequently observed foreign body. Seven of the 12 pediatric patients required an ultrathin bronchoscope (diameter, 2.8 mm) for foreign body removal. Only one patient required a rigid scope in addition to flexible bronchoscopy. The most frequently used instrument was a mini grasping basket forceps (n = 7; 58%), which was used with a 1.2 mm instrument channel (n = 4; 33%). CONCLUSIONS The use of a mini grasping basket forceps in combination with an ultrathin flexible bronchoscope was useful for removing smooth, soft materials such as a nuts or beans in pediatric cases.
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Affiliation(s)
- Atsushi Hata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kota Ohashi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taiki Fujiwara
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takekazu Iwata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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21
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Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis 2017; 9:3398-3409. [PMID: 29221325 DOI: 10.21037/jtd.2017.06.137] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Justin C Hewlett
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Udaya B Prakash
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
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Schramm D, Ling K, Schuster A, Nicolai T. Foreign body removal in children: Recommendations versus real life-A survey of current clinical management in Germany. Pediatr Pulmonol 2017; 52:656-661. [PMID: 27648823 DOI: 10.1002/ppul.23609] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Task forces of the European Respiratory Society (ERS, 2003) and the American Thoracic Society (ATS, 2015) both recommend rigid bronchoscopy for foreign body removal in children. However, there is an increasing number of publications recommending flexible bronchoscopy as primary method for foreign body removal in children. METHODS We therefore initiated a nationwide survey, investigating the routinely used method of foreign body removal in children in different centers in Germany. RESULTS In total, 259 centers took part in the survey. Twenty percent used flexible bronchoscopy as primary method of choice for foreign body removal. Of note, only 40% of the respondents reported that they had attended formal training courses in flexible bronchoscopy, 15% in rigid bronchoscopy, and 42% had never attended a formal training. Twenty-five percent indicated that they had already encountered an emergency situation during or after foreign body removal, requiring intensive care. CONCLUSION Published data shows that rigid bronchoscopy involves fewer complications and is more successful in foreign body removal in children. It is consequently questionable, why 20% of the medical centers report a preference for the flexible method. One reason might be the poor availability of rigid bronchoscopy and the difficulty gaining sufficient expertise in rigid bronchoscopy in Germany. Pediatr Pulmonol. 2017;52:656-661. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Kerstin Ling
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Antje Schuster
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Thomas Nicolai
- Department of Pediatrics, Ludwig-Maximilians-University of Munich, Munich, Germany
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Eyekpegha OJ, Onakpoya UU, Obiajunwa PO, Famurewa OC, Ogunrombi AB. Missed Distal Tracheal Foreign Body in Consecutive Bronchoscopies in a 6-year-old Boy. Niger J Surg 2017; 23:67-70. [PMID: 28584516 PMCID: PMC5441221 DOI: 10.4103/1117-6806.199957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals. He had an initial rigid bronchoscopy which failed to show the foreign body (FB). A chest computerized tomographic scan demonstrated the FB, which was retrieved at combined flexible/rigid bronchoscopy. Although rigid bronchoscopy is the gold standard for managing airway foreign bodies, there remains a false negative rate for this procedure and where necessary, appropriate imaging may compliment rigid bronchoscopy, especially where there is some confusion.
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Affiliation(s)
- Oghenevware Joel Eyekpegha
- Department of Surgery, Cardiothoracic Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Uvie U Onakpoya
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Perpetua O Obiajunwa
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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24
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Vaidya PJ, Leuppi JD, Chhajed PN. The evolution of flexible bronchoscopy: From historical luxury to utter necessity!! Lung India 2015; 32:208-10. [PMID: 25983403 PMCID: PMC4429379 DOI: 10.4103/0970-2113.156212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Joerg D Leuppi
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Department of Medicine, Kantonsspital Liestal, University of Basel, Basel, Switzerland. E-mail:
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
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