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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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Zhang Y, Liang ZR, Xiao Y, Li YS, Fu BJ, Chu ZG. CT Characteristics and Clinical Findings of Bronchopneumonia Caused by Pepper Aspiration. Int J Gen Med 2024; 17:2757-2766. [PMID: 38895049 PMCID: PMC11184221 DOI: 10.2147/ijgm.s464076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To explore the computed tomography (CT) features of bronchopneumonia caused by pepper aspiration to improve the diagnosis. Materials and Methods 28 adult patients diagnosed with obstructive pneumonia caused by pepper aspiration from January 2016 to September 2022 were enrolled. The CT characteristics of bronchial changes and pulmonary lesions caused by pepper were analyzed and summarized. Results Among 28 patients, the most common symptom was cough (26, 92.9%), followed by expectoration (23, 82.1%). Bronchoscopy revealed that peppers were mainly found in the bronchus of the right lower lobe (n = 18, 64.3%), followed by the bronchus of the left lower lobe (n = 5, 17.9%). In combination with bronchoscopy results, the pepper in the bronchus manifested as circular or V/U-shaped high-density, localized soft tissue, and flocculent opacification in 8 (28.6%), 16 (57.1%), and 3 (10.7%) cases on CT images, respectively. The bronchial wall around the pepper was thickened with localized occlusion (n = 19, 67.9%) and stenosis (n = 9, 32.1%). Regarding adjacent bronchi without peppers, extensive wall thickening with stenosis and/or occlusion was found in 23 (82.1%) cases. Distal pulmonary lesions frequently involved two or three segments (21, 75.0%) and mainly presented as patchy consolidation or atelectasis (24, 85.7%). Conclusion In combination to a history of eating peppers and clinical symptoms, bronchopneumonia caused by pepper should be highly suspected if U/V-shaped and annular high-density or localized soft tissue density is detected in the bronchi of the lower lobes, accompanied by extensive bronchial wall thickening, stenosis, or occlusion, and consolidation or atelectasis in multiple distal lung segments.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Radiology, Chongqing Jiangjin Second People’s Hospital, Chongqing Jiangjin Cancer Hospital, Chongqing, 402260, People’s Republic of China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
| | - Yang Xiao
- Department of Respiratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yi-Shi Li
- Department of Respiratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Brixey AG, McCallum R. Imaging of Large Airway Disorders. Clin Chest Med 2024; 45:489-503. [PMID: 38816102 DOI: 10.1016/j.ccm.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Large airway disorders encompass a large variety of diseases and pathology, with broad categories including anatomic variants, congenital abnormalities, acquired abnormalities, inflammatory/infiltrative causes, infection, and tumors. The most common diseases in each category are discussed with a focus on the salient imaging findings. Pitfalls to beware of are discussed through the article, and concludes with a general method to approaching large airways pathology that should provide the reader with a basic framework and understanding of this complex topic.
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Affiliation(s)
- Anupama Gupta Brixey
- Department of Diagnostic Radiology, Section of Cardiothoracic Imaging, Portland VA Healthcare System and Oregon Health & Science University, 3710 Southwest US Veterans Hospital Road, Portland, OR 97239, USA.
| | - Raluca McCallum
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Hong PY, Wang L, Du YP, Wang M, Chen YY, Huang MH, Zhang XB. Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders. Sci Rep 2024; 14:9493. [PMID: 38664527 PMCID: PMC11045842 DOI: 10.1038/s41598-024-60307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Ping-Yang Hong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Ling Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Yan-Ping Du
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Miao Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Yi-Yuan Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Mao-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Key Clinical Specialty of Fujian Province, Fuzhou, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
- Key Clinical Specialty of Fujian Province, Fuzhou, China.
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Georgakopoulou VE, Tarantinos K, Mermigkis D. Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report. Cureus 2024; 16:e57596. [PMID: 38707010 PMCID: PMC11069630 DOI: 10.7759/cureus.57596] [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: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
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.
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Šimon R, Šimonová J, Čuchrač L, Klimčík R, Vašková J. Foreign Body in the Airway Mimicking Tumour in an Adult: A Case Report. Cureus 2024; 16:e58584. [PMID: 38765362 PMCID: PMC11102659 DOI: 10.7759/cureus.58584] [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: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.
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Affiliation(s)
- Róbert Šimon
- 1st Department of Surgery, Pavol Jozef Šafarik University, Košice, SVK
| | - Jana Šimonová
- 1st Department of Anaesthesiology and Intensive Medicine, Pavol Jozef Šafarik University, Košice, SVK
| | - Lukáš Čuchrač
- 1st Department of Anaesthesiology and Intensive Medicine, Pavol Jozef Šafarik University, Košice, SVK
| | - Roman Klimčík
- Department of Pneumology and Phthiseology, Pavol Jozef Šafarik University, Košice, SVK
| | - Janka Vašková
- Department of Medical and Clinical Biochemistry, Pavol Jozef Šafarik University, Košice, SVK
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7
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Tanigaki T, Ogawa T, Nomura S, Ito K, Kurata Y, Matsukida A, Ishihara M, Yoshino A, Kawana A, Kimizuka Y. Severe Atelectasis due to Aspirated Valproic Acid Tablet. Case Rep Pulmonol 2024; 2024:6650141. [PMID: 38529055 PMCID: PMC10963110 DOI: 10.1155/2024/6650141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024] Open
Abstract
A 60-year-old man treated with valproic acid (VPA) for epilepsy developed atelectasis and respiratory failure after an accidentally aspirated VPA tablet-induced mucus hypersecretion. Following bronchoscopic removal of the aspirated tablet, his respiratory status improved and massive sputum production did not recur. We hypothesized that the aspirated VPA tablet increased the expression of mucin-related genes, thereby increasing mucus production. Our in vitro experiments using a human respiratory epithelial cell line revealed that VPA directly upregulates the airway mucin-related genes. We believe that this is the first case report of aspirated VPA-induced severe atelectasis and respiratory failure, which were successfully treated with the bronchoscopic removal of the VPA tablet.
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Affiliation(s)
- Tomomi Tanigaki
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Takunori Ogawa
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Sakika Nomura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Koki Ito
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Yuhei Kurata
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Akira Matsukida
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Morio Ishihara
- Division of Psychiatry, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Aihide Yoshino
- Division of Psychiatry, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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8
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Ng KL, Park J, Belcher E, Moore AJ. Not all wheeze is asthma. Thorax 2024; 79:378-379. [PMID: 38326024 DOI: 10.1136/thorax-2023-220953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Kher Lik Ng
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Park
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alastair J Moore
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hojberg Y, Abdeljaber M, Milewski Y, deJong J, Prahlow JA. Fatal Iron Tablet Aspiration: Importance of Early Diagnosis and Forensic Pathologist Awareness. Am J Forensic Med Pathol 2024:00000433-990000000-00170. [PMID: 38477591 DOI: 10.1097/paf.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
ABSTRACT Pill aspiration is a significant source of foreign body aspiration in the United States and can occur without swallowing dysfunction or illness. Consequences depend on various factors, such as the pill's chemical composition, size, and diagnostic delay. Aspiration of iron tablets poses a higher risk because of hydroxyl radical formation and subsequent caustic burns, inflammation, obstruction, and/or necrosis. We present a case of a middle-aged obese woman who died 3 weeks after aspirating an iron tablet. Autopsy revealed morbid obesity, a necrotic focus in the right middle lobe of the lung, bronchiolar granulation tissue with iron staining foreign matter, extending into an adjacent arteriole, and mural perforation of the hilar right middle lobe. Despite seeking medical attention twice, the patient was only accurately diagnosed postmortem. This case highlights the importance of accurate and timely diagnosis in preventing fatal outcomes. To enhance diagnostic accuracy and reduce morbidity and mortality associated with pill aspiration, clinicians should maintain a high level of suspicion for foreign body aspiration in patients with persistent or worsening respiratory symptoms. Furthermore, it is crucial for forensic pathologists to have a high index of suspicion about the potential for lethal pill aspiration and complications days after the acute event.
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Affiliation(s)
- Yvonne Hojberg
- From the Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Mahmuod Abdeljaber
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Yvonne Milewski
- New York City Office of Chief Medical Examiner, New York, NY
| | - Joyce deJong
- From the Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | - Joseph A Prahlow
- Department of Pathology, St. Louis University School of Medicine; Office of the Medical Examiner, City of St. Louis, St. Louis, MO
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10
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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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11
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Kara K, Ozdemir C, Tural Onur S, Satici C, Tokgoz Akyil F, Nedime Sokucu S. Late Diagnosis of Foreign Body Aspiration in Adults: Case Series and Review of the Literature. Respir Care 2024; 69:317-324. [PMID: 37935526 PMCID: PMC10984597 DOI: 10.4187/respcare.10723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS Of the 255 patients with FBA, 17.6% (N = 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Forty-two percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue.
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Affiliation(s)
- Kaan Kara
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey.
| | - Cengiz Ozdemir
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Seda Tural Onur
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Celal Satici
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Fatma Tokgoz Akyil
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Sinem Nedime Sokucu
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
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Doppalapudi S, Fortuzi K, Qasim A, Yordanka DS, Khaja M. Glass in the Airways: A Bronchoscopic Challenge. Cureus 2024; 16:e53344. [PMID: 38435889 PMCID: PMC10907552 DOI: 10.7759/cureus.53344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever. These varied presentations, coupled with the fact that many other medical conditions can mimic the respiratory symptoms seen in FBA, make diagnosis challenging. A high index of suspicion is often required, especially in cases where the patient's history does not clearly point toward aspiration. Immediate management focuses on supporting the airway, which is crucial given the potential for severe obstruction. Radiographic imaging plays a key role in localizing the foreign body, which is vital for planning its removal. Bronchoscopy, particularly flexible bronchoscopy, is the cornerstone of both diagnosis and treatment. This technique allows for direct visualization of the airways, localization of the foreign body, and its subsequent removal. This is crucial to avoid long-term complications, which can arise if the foreign body is not promptly and effectively removed. In this case report, we present a 64-year-old female patient who was found to have a foreign object positioned in the right lower lobe of the lungs that was removed via flexible bronchoscopy.
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Affiliation(s)
- Sai Doppalapudi
- Pulmonary and Critical Care Medicine, BronxCare Hospital, New York City, USA
| | - Ked Fortuzi
- Pulmonary Medicine, BronxCare Hospital, New York City, USA
| | - Abeer Qasim
- Internal Medicine, BronxCare Hospital, New York City, USA
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13
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Flacks NH, Steen CJ, Kong JC. Dental hygiene and gut health: a surgical case of a misplaced dental drill bur. ANZ J Surg 2023; 93:3012-3013. [PMID: 37654123 DOI: 10.1111/ans.18681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Affiliation(s)
| | | | - Joseph C Kong
- Department of Surgery, Cabrini Hospital, Melbourne, Australia
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14
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Barthwal M, Dole S, Manjush R, Sahasrabudhe T. Clove stalk aspiration: An unusual cause of chronic cough. Med J Armed Forces India 2023; 79:S352-S354. [PMID: 38144634 PMCID: PMC10746793 DOI: 10.1016/j.mjafi.2022.04.012] [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: 11/12/2021] [Accepted: 04/18/2022] [Indexed: 10/17/2022] Open
Abstract
Foreign body aspiration in adults is one of the uncommon causes of chronic cough and may be missed if the patient already has a known cause of chronic cough, but the same is not responding to therapy. A 72-year-old male patient, a known case of allergic rhinitis, presented with a history of cough for 6 months. There was unsatisfactory response to treatment with antibiotics, inhalational corticosteroids, oral corticosteroids, bronchodilators, and antireflux treatment. High-resolution computed tomography was normal. However, fiber optic bronchoscopy revealed a foreign body in the right lower lobe, which was removed and was identified as clove stalk. This led to rapid relief of symptoms. Clove stalk aspiration is an unusual foreign body causing chronic cough, which has not yet been reported.
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Affiliation(s)
- M.S. Barthwal
- Professor & Head (Respiratory Medicine), Dr DY Patil Medical College, Hospital & Research Centre, Pimpri, Pune, India
| | - Sachinkumar Dole
- Associate Professor (Respiratory Medicine), Dr DY Patil Medical College, Hospital & Research Centre, Pimpri, Pune, India
| | - R.M. Manjush
- Resident (Respiratory Medicine), Dr DY Patil Medical College, Hospital & Research Centre, Pimpri, Pune, India
| | - Tushar Sahasrabudhe
- Professor (Respiratory Medicine), Dr DY Patil Medical College, Hospital & Research Centre, Pimpri, Pune, India
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15
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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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16
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Grounds GS, Dent H, Nunes C, Dhar V. Tubeless field anaesthesia for surgical removal of an aspirated endoscopy capsule. Anaesth Rep 2023; 11:e12242. [PMID: 37588044 PMCID: PMC10425334 DOI: 10.1002/anr3.12242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Capsule endoscopy is a safe, minimally invasive procedure used to investigate gastrointestinal bleeding of unknown origin that persists or recurs after a negative initial endoscopy. The most common adverse effects of capsule endoscopy include abdominal pain, nausea and vomiting. Capsule pulmonary aspiration, although a rare complication, has been reported in the literature. Most reported cases resolve without further medical intervention. In these cases, the capsule is either expelled by coughing, or it re-enters the oropharynx and is then swallowed. In a small number of cases, the capsule remains in the lung, unable to be expectorated. This requires prompt diagnosis and emergency bronchoscopic removal under general anaesthesia. Due to the smooth, rounded surfaces of the capsule, it may be difficult to grasp, and consequently extraction may be technically challenging. The existing literature contains limited documentation on anaesthetic and surgical approaches for managing an aspirated endoscopy capsule. In this case report, we present the management of an aspirated endoscopy capsule in a district general hospital, in which thoracic surgery was not available. Local resources were used to manage this potentially life-threatening complication without patient transfer. In our case, we provided a tubeless field to optimise surgical access. This facilitated the successful surgical extraction of the endoscopy capsule from the left main bronchus.
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Affiliation(s)
- G. S. Grounds
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - H. Dent
- Department of AnaesthesiaKent and Canterbury HospitalCanterburyKentUK
| | - C. Nunes
- Department of GastroenterologyKent and Canterbury HospitalCanterburyKentUK
| | - V. Dhar
- Department of Ear, Nose and Throat SurgeryWilliam Harvey HospitalAshfordKentUK
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17
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Barreto I, Silva R, Moreira S. Foreign Body Aspiration With a Rare Presentation in the Adult. OPEN RESPIRATORY ARCHIVES 2023; 5:100259. [PMID: 37588695 PMCID: PMC10425673 DOI: 10.1016/j.opresp.2023.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Inês Barreto
- Department of Pulmonology, North Lisbon University Hospital Centre, Portugal
| | - Raquel Silva
- Department of Pulmonology, North Lisbon University Hospital Centre, Portugal
| | - Susana Moreira
- Department of Pulmonology, North Lisbon University Hospital Centre, Portugal
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18
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Chettri MN, Das S, Sharma HS, Bhutia MP, Rai R. Rigid Bronchoscopy-Brief Insight and Encounters in a Tertiary Hospital. Indian J Otolaryngol Head Neck Surg 2023; 75:1016-1019. [PMID: 37274974 PMCID: PMC10234998 DOI: 10.1007/s12070-022-03295-8] [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: 02/03/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
A brief insight of Rigid Bronchoscopy and methodology in current times in a tertiary care centre and a series of 3 recent unusual encounters of foreign body removed through rigid bronchoscopy.
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Affiliation(s)
- Mohonish N. Chettri
- Present Address: Department of ENT Head and Neck Surgery, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, 5Th Mile Tadong, Gangtok, Sikkim 737102 India
| | | | | | - Meyong P. Bhutia
- Department of Anaesthesia, Sikkim Manipal University, Gangtok, Sikkim 737102 India
| | - Ram Rai
- Department of Anaesthesia, Sikkim Manipal University, Gangtok, Sikkim 737102 India
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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [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: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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20
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Schweigert M, Parschke P, Almeida AB, Kellner P. Aspiration of a Blister Pack Tablet with Tracheal Obstruction and Perforation: Emergency Tracheal Repair with Extracorporeal Membrane Oxygenation Support. Thorac Cardiovasc Surg Rep 2023; 12:e57-e59. [PMID: 37936924 PMCID: PMC10626524 DOI: 10.1055/s-0043-1776110] [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: 04/09/2023] [Accepted: 08/10/2023] [Indexed: 11/09/2023] Open
Abstract
Background Airway management in case of acute tracheal injury is a challenging situation where the use of Extracorporeal Membrane Oxygenation (ECMO) has recently gained more importance. Case Description We report the case of a 60-year old women with aspiration of a large blister pack tablet causing acute tracheal obstruction with asphyxia as well as tracheal perforation with tension pneumothorax. As bronchoscopy failed to retrieve the blister pack, emergency tracheal reconstruction with Extracorporeal Membrane Oxygenation (ECMO) support was carried out. Conclusion The application of ECMO instantly alleviated the acute situation and provided excellent conditions for technically demanding emergency tracheal repair.
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Affiliation(s)
- Michael Schweigert
- Department of Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Patrick Parschke
- Department of Pulmonology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Ana Beatriz Almeida
- Department of Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Patrick Kellner
- Department of Anesthesia and Intensive Care, University Hospital Schleswig-Holstein, Luebeck, Germany
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21
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Muacevic A, Adler JR. Using Machine Learning Technique to Predict the Most Reliable Diagnostic Finding for Foreign Body Aspiration in Children: Symptoms, Chest X-ray, or Auscultation? Cureus 2022; 14:e32461. [PMID: 36644063 PMCID: PMC9834759 DOI: 10.7759/cureus.32461] [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: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Foreign body aspiration (FBA) is one of the most critical and life-threatening pediatric emergency situations. Prompt diagnosis in these cases is very important as they are associated with high mortality among children. When diagnosing FBA, symptoms of the patient, auscultation findings, and chest X-ray findings are usually evaluated. In this study, we conducted a retrospective analysis of all the cases involving suspicion of FBA in children under the age of 18 years who were hospitalized in the Department of Pediatric Surgery at Denizli Pamukkale University Hospital, Turkey from January 2005 to September 2020. Instead of traditional statistical methods, we used machine learning techniques such as random forest and logistic regression to determine which finding was diagnostically the most reliable. The variables included in the analysis that were considered to be significant were as follows: symptoms, auscultation findings, chest X-ray findings, patient gender, age, location of the foreign body, and the time of admission. For the purpose of this study, we developed four different models. Model 1 included gender, age, time of admission, location, and symptoms as variables; the correct classification rate of the model was found to be 82.3%. Model 2 included auscultation findings in addition to Model 1, and the correct classification rate of the model was 84.8%. Model 3 included chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.4%. Model 4, on the other hand, included both auscultation findings and chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.6%. Based on our findings, a definitive diagnosis of FBA using only symptoms, auscultation findings, or chest X-ray findings in isolation does not seem possible. Additionally, using only symptoms and chest X-ray findings is also insufficient to make a diagnosis.
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22
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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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23
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Risal R, Aung HM, Jahir T, Subedi KR, Hossain S, Thida AM, Schmidt M, Enriquez D. Endobronchial Foreign Bodies Presenting as Intermittent Chest Pain and Productive Cough. Cureus 2022; 14:e29599. [DOI: 10.7759/cureus.29599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
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24
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Bukhari DH, Kabli AF, Alharthi TS, Sendi E, Rashed AA. A Rare Case of a Vocal Cord Foreign Body in an Infant: A Case Report. Cureus 2022; 14:e29213. [PMID: 36259039 PMCID: PMC9569188 DOI: 10.7759/cureus.29213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
Abstract
A foreign body (FB) is an object or item that is foreign to the area in which it is found. FB in the airway, accompanied by the esophagus, is a common overnight emergency in pediatric otolaryngology. Here we report a case of a healthy 11-month-old girl who presented in the emergency room with stridor and a weak cry. The patient was admitted as a case of croup (laryngotracheobronchitis) and treated with multiple antibiotics for more than five days but showed no improvement, then consulted the ear, nose, and throat team (ENT).
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25
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Liu X, Ni F, Guo T, Jiang F, Jiang Y, Song C, Yuan M, Tao Z, Ye M, Xu J, Wang Y, Qian Q, Hu Y, Wang Y. Risk factors associated with radiolucent foreign body inhalation in adults: a 10-year retrospective cohort study. Respir Res 2022; 23:238. [PMID: 36088318 PMCID: PMC9463778 DOI: 10.1186/s12931-022-02165-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Xiaofan Liu
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Fang Ni
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Tao Guo
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Fangfang Jiang
- Department of Mathematical Sciences, Faculty of Social Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Yan Jiang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Cheng Song
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Mingli Yuan
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Zhaowu Tao
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Mingxin Ye
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Junjie Xu
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Ying Wang
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Qiong Qian
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Yi Hu
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
| | - Yihua Wang
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, SO16 6YD, UK.
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26
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Awonusi O, Halum S. Airway foreign body retrieval in a tracheostomy-dependent patient with severe laryngeal stenosis. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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27
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Shah S, Howard J, Winston N. Foreign Body in the Glottis. Cureus 2022; 14:e24428. [PMID: 35637797 PMCID: PMC9127377 DOI: 10.7759/cureus.24428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
This case report highlights some of the anesthetic challenges of an airway foreign body removal. We present a case report of foreign body removal in a 50-year-old male with an oxtail bone lodged between the vocal cords. We used face mask general anesthesia with sevoflurane.
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28
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Lei W, Gan ZY, Liang YF, Liang CX, Jin CZ, Peng WP, Qiu XC, Guo HY. Airway foreign body caused by pepper inhalation 7 years previously retrieved under conscious sedation with spontaneous respiration: a case report. J Int Med Res 2022; 50:3000605221086146. [PMID: 35296168 PMCID: PMC8943315 DOI: 10.1177/03000605221086146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old man who had inhaled a dried pepper 7 years previously was admitted to our hospital for repeated coughing with yellow sputum and occasional hemoptysis. A thoracic high-resolution computed tomography scan revealed a foreign body at the proximal end of the right lower bronchus. We attempted to remove the foreign body by flexible bronchoscopy, but this was unsuccessful because the foreign body fell deeper into the bronchus. After a multidisciplinary team meeting, the foreign body was successfully extracted by bronchoscope suction and forceps under conscious sedation with spontaneous respiration. We avoided rigid bronchoscopy and traumatic surgery, thus decreasing the patient's risk and cost. We herein share our successful experience with this case.
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Affiliation(s)
- Wei Lei
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China.,Southern Medical University, Guangzhou City, Guangdong Province 510515, China
| | - Zhen-Yong Gan
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Yong-Feng Liang
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Cai-Xia Liang
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Cang-Zheng Jin
- Department of Radiology, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Wei-Ping Peng
- Department of Anesthesiology, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Xin-Cai Qiu
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
| | - Hai-Yan Guo
- Department of Respiratory Medicine, The Sixth Affiliated Hospital, South China University of Technology (The People's Hospital of Nanhai), Foshan City, Guangdong Province 528222, China
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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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Impacted gutkha presenting as an intrabronchial mass lesion leading to post-obstructive pneumonia. Respir Med Case Rep 2022; 37:101616. [PMID: 35342705 PMCID: PMC8941267 DOI: 10.1016/j.rmcr.2022.101616] [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: 11/04/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
A 66-year-old man presented with a chief complaint of difficulty breathing and productive cough. CT scan of the chest revealed an endobronchial mass with associated “tree-in-bud” opacities. A bronchoscopic biopsy of the mass was performed due to clinical suspicion of malignancy. Microscopic examination revealed inflamed endobronchial mucosa, granulation tissue and abundant fragments of uncharacterized organic material, compatible with aspiration. Detailed history revealed a history of chewing “gutkha”, a form of smokeless tobacco comprising a mixture of betel nut and other condiments. Microscopic sections of a betel nut and the “gutkha mix” processed subsequently in the histology laboratory were found to be similar to the organic material found in the mass. Thus, a diagnosis of impacted betel nut mixture leading to post-obstructive pneumonia was rendered.
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Li L, Li MJ, Sun L, Jiang YL, Zhu J. Neglected Foreign Body Aspiration Mimicking Lung Cancer Recurrence. Healthc Policy 2022; 15:491-496. [PMID: 35321269 PMCID: PMC8935719 DOI: 10.2147/rmhp.s361081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
Foreign body aspiration (FBA) occurs less frequently in adults than in children. Case reports of FBAs occurring in adults after lung surgery are not found in the literature, and this particular condition is often misdiagnosed. We report a case in which the patient was diagnosed after various events. A 56-year-old female patient had undergone robotic-assisted resection of the right upper lobe. The patient recovered well after the operation, with a slight irritant dry cough. Chest computed tomography (CT) examination of the patient showed no obvious abnormality early postoperatively. However, she developed intermittent cough and hemoptysis at six months. Repeat chest CT showed a soft tissue shadow near the bronchus in the lower lobe of the right lung. Cancer recurrence, surgery-related foreign body residue, lymphoid reactive hyperplasia, or other reasons was considered. Further examination revealed a piece of watermelon seed shell blocking the bronchial opening of the lower lung. This case highlights the importance of medical history, careful physical examination and fiberoptic bronchoscopic examination after lung cancer surgery due to lung cancer recurrence risk or FBA.
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Affiliation(s)
- Lei Li
- Department of the First Surgery, Wuhan Jin-Yin-Tan Hospital, Wuhan, 430011, People’s Republic of China
| | - Meng-Jie Li
- Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, 062650, People’s Republic of China
| | - Liu Sun
- Department of Otolaryngology-Head and Neck Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China
| | - Yuan-Liang Jiang
- Department of Radiology, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China
- Correspondence: Jian Zhu; Yuan-Liang Jiang, General Hospital of Central Theater Command of the People’s Liberation Army, 627#, Wuluo Road, Wuchangqu, Wuhan, Hubei, 430070, People’s Republic of China, Tel +86-13871166489, Fax +86-27-50772388, Email ;
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Ayats-Vidal R, Vásquez-Pérez A, Gallego-Díaz M, Rosell A, Valdesoiro-Navarrete L, Tazi-Mezalek R. Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child. Respir Med Case Rep 2022; 36:101594. [PMID: 35242515 PMCID: PMC8866066 DOI: 10.1016/j.rmcr.2022.101594] [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: 07/20/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation.
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Arana Ribeiro J, Martins Natal R, Matos Gomes R. Dental implant screwdriver aspiration. Pulmonology 2022; 28:239-240. [DOI: 10.1016/j.pulmoe.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/15/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022] Open
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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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Torii A, Saka H, Clapp T, Eitel C, Honjo C, Anzai M, Oki M. Removal of a foreign body by rigid bronchoscope after virtual reality-aided presurgical planning: A case report. Respir Med Case Rep 2022; 38:101698. [PMID: 35814034 PMCID: PMC9260293 DOI: 10.1016/j.rmcr.2022.101698] [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: 03/24/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Adi O, Baherin MF, Fong CP, Fatan AAA, Ahmad AH, Yusof AA, Khan FA. Emergency physician-performed emergency bronchoscopy in cardiac arrest patient due to acute foreign body airway obstruction. Am J Emerg Med 2021; 53:23-28. [PMID: 34968971 DOI: 10.1016/j.ajem.2021.12.027] [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: 09/21/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022] Open
Abstract
As foreign body airway obstruction (FBAO) can be life-threatening, it has to be promptly diagnosed and treated. We report a case series of three patients presenting to the emergency department with cardiac arrest due to FBAO. In each case, ventilation was difficult due to high airway resistance. As FBAO was suspected, the emergency physician did a prompt flexible bronchoscopy to confirm the diagnosis and retrieve the foreign body. Flexible bronchoscopy is an important diagnostic and therapeutic tool for emergency airway management, and is a relatively safe procedure if performed by a trained personnel. The life-saving benefits of bronchoscopy outweigh the small risks of complications such as bleeding, desaturation and pneumothorax. In the three cases, the removal of the obstructing material led to immediate improvements in oxygenation and ventilation. The patients had return of spontaneous circulation after cardiopulmonary resuscitation and definite airway control.
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Affiliation(s)
- Osman Adi
- Senior Consultant Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Muhammad Faiz Baherin
- Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia; Trauma & Emergency Department, Tuanku Ja'afar Hospital, Seremban, Negeri Sembilan, Malaysia
| | - Chan Pei Fong
- Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Ahmad AbdulBasitz Ahmad Fatan
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Azma Haryaty Ahmad
- Emergency Physician & ED Critical Care, Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Alhady Alfian Yusof
- Consultant Emergency Medicine & Consultant Medical Intensive Care Unit Hamad General Hospital, Doha, Qatar
| | - Faheem Ahmed Khan
- Consultant Intensivist & Consultant Emergency Physician, Chief, Department of Intensive Care, Ng Teng Fong Hospital, Singapore
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Bowden ET, Smith P, Dwyer KM. Pill aspiration: an under-recognised clinical entity. Med J Aust 2021; 215:505-506. [PMID: 34763364 DOI: 10.5694/mja2.51337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022]
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38
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Ishimoto H, Sakamoto N, Moriyama S, Murata M, Nakada N, Hara A, Kido T, Yamaguchi H, Yamamoto K, Obase Y, Ishimatsu Y, Mukae H. Removal of an aspirated tooth from the bronchus using a cryoprobe: A case report. Respirol Case Rep 2021; 9:e0880. [PMID: 34853696 PMCID: PMC8612864 DOI: 10.1002/rcr2.880] [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: 10/06/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/06/2022] Open
Abstract
An 88-year-old bedridden man with Alzheimer's disease developed fever and hypoxaemia. Chest radiography showed obstructive pneumonia caused by a foreign body in the airway. Examination using a flexible bronchoscope revealed a silver-crowned molar, thought to have fallen out due to root caries, at the left lower lobe branch. Removal of the foreign body was unsuccessful with grasping or basket forceps, but successful with cryoadhesion using a cryoprobe. Removal of an airway foreign body by a cryoprobe depends on the nature of the foreign body, namely its water content. Therefore, cryoprobes are not inherently suitable for removing foreign bodies of aspirated teeth, but a tooth covered with mucus for a long time after aspiration can be cryoadhered with cryoprobes. Airway foreign bodies that remain in the airway for a long time should also be considered for removal by cryoprobe, regardless of the water content of the material.
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Affiliation(s)
- Hiroshi Ishimoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Noriho Sakamoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Sakiko Moriyama
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Mayako Murata
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Division of Respiratory MedicineSaiseikai Nagasaki HospitalNagasakiJapan
| | - Nana Nakada
- Division of Respiratory MedicineSaiseikai Nagasaki HospitalNagasakiJapan
| | - Atsuko Hara
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takashi Kido
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroyuki Yamaguchi
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Kazuko Yamamoto
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yasushi Obase
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yuji Ishimatsu
- Department of NursingNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroshi Mukae
- Department of Respiratory MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
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Zhu Y, Fan Q, Cheng L, Chen B. Diagnostic Errors in Initial Misdiagnosis of Foreign Body Aspiration in Children: A Retrospective Observational Study in a Tertiary Care Hospital in China. Front Pediatr 2021; 9:694211. [PMID: 34722414 PMCID: PMC8555661 DOI: 10.3389/fped.2021.694211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Foreign body aspiration (FBA) in children is a common emergency that can easily be missed, leading to delays in treatment. Few large cohort studies have focused on errors in diagnostic assessment. The main purpose of this study was to analyze factors contributing to the initial misdiagnosis of FBA in children. Methods: We retrospectively reviewed the charts of 226 children diagnosed with FBA at the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2018 to November 2020. Cases were divided into two groups according to whether or not patients were initially misdiagnosed. The clinical characteristics of the two groups were then compared. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was applied to cases with initial misdiagnosis. Results: Of the 226 included children with a final diagnosis of FBA, 153 (67.7%) were boys. Ninety percent of patients were under 3 years old. More than half (61.9%) of the children were referred from primary institutions, and 38.1% visited tertiary hospitals directly. A total of 80 (35.4%) patients were initially misdiagnosed. More than half of misdiagnosed children received an alternative diagnosis of bronchiolitis (51.3%), the most common alternative diagnosis. Test failures (i.e., errors in test ordering, test performance, and clinician processing) were primarily responsible for the majority of initial diagnostic errors (76.3%), followed by failure or delay in eliciting critical case history information (20.0%). Characteristics significantly associated with initial misdiagnosis were: presentation over 24 h (OR 9.2, 95% CI 4.8-17.5), being referred from primary institutions (OR 8.8, 4.1-19.0), no witnessed aspiration crisis (OR 7.8, 3.0-20.3), (4) atypical signs or symptoms (OR 3.2, 1.8-5.7), foreign body not visible on CT (OR 36.2, 2.1-636.8), foreign body located in secondary bronchi (OR 4.8, 1.3-17.2), organic foreign body (OR 6.2, 1.4-27.2), and history of recurrent respiratory infections (OR 2.7, 1.4-5.3). Children with misdiagnosis tended to have a longer time from symptom onset to the definitive diagnosis of FBA (P < 0.001). Conclusions: More than one-third of children with FBA were missed at first presentation. Errors in diagnostic testing and history taking were the main reasons leading to initial misdiagnosis.
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Affiliation(s)
- Yingchao Zhu
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qijun Fan
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lijun Cheng
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Bobei Chen
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
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40
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Shotton S, Kumar V, Fahmay Y. The cough and the coffee. QJM 2021; 114:412-413. [PMID: 33638347 DOI: 10.1093/qjmed/hcab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Shotton
- From the Department of Respiratory Medicine, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, UK
| | - V Kumar
- Department of Respiratory Medicine, Kettering General Hospital, Rothwell Road, Kettering NN16 8UZ, UK
| | - Y Fahmay
- From the Department of Respiratory Medicine, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, UK
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41
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Reyad HM, El-Deeb ME, Abbas AM, Sherief D, Elagamy OA. Foreign Body Aspiration in Egyptian Children Clinical, Radiological and Bronchoscopic Findings. J Multidiscip Healthc 2021; 14:2299-2305. [PMID: 34465998 PMCID: PMC8403025 DOI: 10.2147/jmdh.s326967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Foreign body aspiration (FBA) is a frequent cause of childhood morbidity and mortality. Diagnosis of FBA is challenging in the absence of a witnessed aspiration event. The aim of this study was to determine the accuracy of presenting symptoms as well as physical and radiologic findings as predictors of FBA in children. Thus, indications for bronchoscopy could be determined in such cases. Methods This retrospective cohort study was conducted in the ENT department, Kafr-elsheikh University Hospital. The medical records of patients younger than 16 years old who underwent rigid bronchoscopy for suspected FBA were included. Data including age, gender, symptoms, physical examination findings, radiological features, nature and location of foreign body, and outcome of the bronchoscopy were collected. Results This study included 130 patients, 105 (80.8%) patients were positive for the presence of a foreign body in their airways. Foreign bodies were most frequently (43.8%) lodged in the right main bronchus, and nuts (66.7%), were the most commonly retrieved. Multivariate regression analysis identified the presence of suggestive signs or symptoms as independent predictors of FBA on rigid bronchoscopy. Conclusion Objective finding of clinical signs eg unilateral wheezes on chest examination in the presence of symptoms such as a sudden cough, dyspnea, and hoarseness could predict FBA and help physicians in deciding bronchoscopy.
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Affiliation(s)
- Heba M Reyad
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed E El-Deeb
- Department of Otorhinolaryngology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ahmed M Abbas
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Dalia Sherief
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Osama A Elagamy
- Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Abraham ZS, Bukanu F, Kimario OM, Kahinga AA. Unusual longstanding intrabronchial foreign body masquerading as intractable bronchial asthma in an adult: Case report and literature review. Int J Surg Case Rep 2021; 86:106340. [PMID: 34454216 PMCID: PMC8405978 DOI: 10.1016/j.ijscr.2021.106340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction and importance Tracheo-bronchial foreign body inhalation is a very common encounter in clinical practice among pediatric patients and rarely seen among adults. When inhalation of foreign bodies occurs in adults then it tends to lodge within the right bronchial tree but in children it lodges in the central airways. Case presentation We present a 58 year old woman, known asthmatic for 20 years and non-smoker who presented to our clinic which history of chronic cough, wheezing and pulmonary infections that did not respond to regular antibiotics and the usual antiasthmatic medications. She reported to have inhaled a foreign body about 18 years earlier. Extraction of the foreign body was performed without complications. Clinical discussion A chest x-ray done was found to be normal and computerized tomography scan (CT scan) of the chest was ordered and revealed bronchial wall thickening with a calcified foreign body seen in the right intermediate bronchus. A combined rigid and flexible endoscopic bronchoscopy was performed and a chicken bone (measuring 2 cm × 1.5 cm) was extracted from the right intermediate bronchus with very minimal bleeding being encountered during and post bronchoscopy. Extraction of the foreign body was performed without complications. Post endoscopic intrabronchial foreign body removal, the patient recovered completely. Conclusion An intrabronchial foreign body being masked for more than a decade by co-existent bronchial asthma is a rare encounter. Moreover, adult patients with chronic cough should be handled with caution to rule out the possibility of FB aspiration. FB inhalation is a very common encounter in clinical practice among pediatric patients and rarely seen among adults. Inhaled FBs in adults tends to lodge within the right bronchial tree and in the central airways in children. Adult patients with chronic cough should be handled with caution to rule out inhaled FBs. Co-existing bronchial asthma may mask the diagnosis of FB inhalation in unclear history of its inhalation. Bronchoscopy remains to be the main stay in management of inhaled FBs.
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Affiliation(s)
| | - Faustine Bukanu
- Department of Otorhinolaryngology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Olivia Michael Kimario
- Department of Otorhinolaryngology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Aveline Aloyce Kahinga
- Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Fukuda M, Nabeta M, Uzu H, Takasu O. Food-related choking among older adults. J Am Coll Emerg Physicians Open 2021; 2:e12514. [PMID: 34296209 PMCID: PMC8286117 DOI: 10.1002/emp2.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Masafumi Fukuda
- Advanced Emergency and Critical Care CenterKurume University HospitalKurumeFukuokaJapan
| | - Masakazu Nabeta
- Advanced Emergency and Critical Care CenterKurume University HospitalDepartment of Emergency and Acute Intensive Care MedicineKurume University School of MedicineKurumeFukuokaJapan
| | - Hideaki Uzu
- Advanced Emergency and Critical Care CenterKurume University HospitalDepartment of Emergency and Acute Intensive Care MedicineKurume University School of MedicineKurumeFukuokaJapan
| | - Osamu Takasu
- Advanced Emergency and Critical Care CenterKurume University HospitalDepartment of Emergency and Acute Intensive Care MedicineKurume University School of MedicineKurumeFukuokaJapan
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Sharifpour A, Hoseini A, Nekoukar Z, Banimostafavi ES, Fakhar M, Soleymani M, Zakariaei Z, Navaeifar MR, Rsouli K. The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration. Ann Med Surg (Lond) 2021; 68:102653. [PMID: 34341688 PMCID: PMC8320400 DOI: 10.1016/j.amsu.2021.102653] [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] [Received: 06/28/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Aref Hoseini
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Nekoukar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Radiology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Pediatric Infectious Disease Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Reza Navaeifar
- Pediatric Infectious Disease Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kimia Rsouli
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Saeed Bamashmos A, Heshmetzadeh Behzadi A, Elfatairy K, Megahed A, Kochar P, Hegde R. Foreign bodies of body orifices: A pictorial review. Clin Imaging 2021; 80:180-189. [PMID: 34333353 DOI: 10.1016/j.clinimag.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ingestion, inhalation, and insertion of foreign bodies (FB) are commonly encountered problems in the emergency departments (ED). Radiologists pay a key role in their diagnosis and management. Selecting an appropriate imaging modality is important depending on the route of entry and reported type of FB. Diagnosing FB is time sensitive and requires radiologists to be astute and familiar with varied imaging appearances of FB. In this article, we review imaging features of most common FB seen in clinical practice and their complications. TEACHING POINTS SUMMARY: FB in body orifices are frequently seen in the ED. Imaging plays a pivotal role in the management in majority of the cases. In this article, we present several cases of commonly encountered FB.
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Affiliation(s)
- Anas Saeed Bamashmos
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States.
| | | | - Kareem Elfatairy
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
| | - Ayah Megahed
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
| | - Puneet Kochar
- Penn State Hershey Milton S Hershey Medical Center, Hershey, PA, United States
| | - Rahul Hegde
- Department of Radiology, Bridgeport Hospital, Yale Newhaven Health, CT, United States
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Miller A, Wenstrup J, Antic S, Shah C, Lentz RJ, Panovec P, Massion PP. A 56-Year-Old Man With Chronic Cough, Hemoptysis, and a Left Lower Lobe Infiltrate. Chest 2021; 159:e53-e56. [PMID: 33422242 PMCID: PMC8256437 DOI: 10.1016/j.chest.2020.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 10/22/2022] Open
Abstract
CASE PRESENTATION A 56-year-old man presented to the lung nodule clinic with abnormal chest imaging prompted by a chronic cough and hemoptysis. Approximately 2.5 years earlier, while kneeling beside his car fixing a flat tire, he fell backwards while holding the tire cap in his mouth, causing him to inhale sharply and aspirate the cap. He immediately developed an intractable cough productive of flecks of blood. He presented to an emergency room but left before being seen because of a long wait time and his lack of health-care insurance. He self-medicated for severe cough and chest discomfort with codeine, eventually developing a dependency. Approximately 3 weeks after aspirating the tire cap, his cough became productive, and he developed fever and chills. His symptoms improved transiently with antibiotics and additional narcotics. Ultimately, his chronic cough with intermittent hemoptysis affected his ability to work, and 30 months later he sought medical attention and was diagnosed with pneumonia and reactive airway disease. He was prescribed doxycycline, steroids, inhaled albuterol, and dextromethorphan, with initial improvement, but his symptoms recurred multiple times despite quitting smoking, leading to repeated medication courses.
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Affiliation(s)
- Alexandra Miller
- Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Janelle Wenstrup
- Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Sanja Antic
- Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Chirayu Shah
- Vanderbilt University Medical Center Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Robert J Lentz
- Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Thoracic Surgery, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Parker Panovec
- Faith Family Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Pierre P Massion
- Vanderbilt University Medical Center Pulmonary/Critical Care Division, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN; Vanderbilt University Medical Center Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN; Cancer Early Detection and Prevention Initiative, Vanderbilt-Ingram Cancer Center, Nashville, TN.
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47
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Asymptomatic fixed partial denture aspiration: A case report. Ann Med Surg (Lond) 2021; 66:102391. [PMID: 34040775 PMCID: PMC8141520 DOI: 10.1016/j.amsu.2021.102391] [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: 04/07/2021] [Revised: 04/28/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Foreign body aspiration (FBA) is more frequently presented in children and considered a rare presentation in adults. One of the most common causes of FBA in adults are orthodontic appliances. Case presentation We present a case of a 70-year-old male with an accidently discovered fixed partial denture (bridge) in the right mainstem bronchus. The partial denture was removed successfully by flexible bronchoscopy. Clinical discussion FBA is an event that most frequently occurs with children, and rarely with adults having various risk factors and complications on patients. Conclusion This study aims to spotlight the danger of asymptomatic FBA and how retrieving sharp objects can be managed by flexible bronchoscopy thus leading to better management and increased awareness of such cases. Foreign Body Aspiration (FBA) is very uncommon in adults. Dental procedures and appliances are considered the second most common leading cause of FBA. High level of physicians' susception is needed to identify FBA cases in adults is needed. Flexible bronchoscopy has an important role in retrieving aspirated foreign bodies.
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Hortobagyi D, Anderhuber W, Tervonen H. [The occult foreign body in the larynx]. HNO 2021; 70:236-238. [PMID: 33830301 PMCID: PMC8866264 DOI: 10.1007/s00106-021-01043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/02/2022]
Affiliation(s)
- David Hortobagyi
- Hals-Nasen-Ohren-Universitätsklinik, Medizinische Universität Graz, Auenbruggerplatz 26, 8036, Graz, Österreich.
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Voulgarelis S, Stucke A. Retrieving multiple magnetic foreign bodies from the glottic entrance and stomach: A case report. Saudi J Anaesth 2021; 15:56-58. [PMID: 33824646 PMCID: PMC8016056 DOI: 10.4103/sja.sja_867_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022] Open
Abstract
Aspiration and ingestion of foreign bodies present a frequent challenge in pediatric anesthesia practice that requires careful planning of the time and the method of retrieval. We discuss the management of a 20-month-old boy who had ingested multiple small magnetic beads and presented emergently to the operating room with two beads lodged in the vallecula and eighteen more forming a chain in the stomach. Benefitting from their magnetic properties, the beads located close to the glottic entrance could be removed by placing a steel Magill forceps close to the objects and using magnetic pull rather than grasping. The beads in the stomach were removed en bloc due to their magnetic properties using an endoscopic retrieval basket. Small beads can be difficult to remove, however, in this case it was possible to utilize their magnetic properties during the removal process.
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Affiliation(s)
- Stylianos Voulgarelis
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Astrid Stucke
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
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50
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Nishiki K, Ishige Y, Kawasaki Y, Mizuno S. Foreign body removed using curette and retrieval net after tracheostomy. Lung India 2021; 38:199-200. [PMID: 33687020 PMCID: PMC8098898 DOI: 10.4103/lungindia.lungindia_957_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kazuaki Nishiki
- Department of Respiratory Medicine, Kanazawa Medical University, Daigaku, Uchinada-Machi, Kahoku-Gun, Ishikawa, Japan
| | - Yoko Ishige
- Department of Respiratory Medicine, Kanazawa Medical University, Daigaku, Uchinada-Machi, Kahoku-Gun, Ishikawa, Japan
| | - Yasutaka Kawasaki
- Department of Respiratory Medicine, Kanazawa Medical University, Daigaku, Uchinada-Machi, Kahoku-Gun, Ishikawa, Japan
| | - Shiro Mizuno
- Department of Respiratory Medicine, Kanazawa Medical University, Daigaku, Uchinada-Machi, Kahoku-Gun, Ishikawa, Japan
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