Late Presentation of Tracheobronchial Foreign Body Aspiration in Children

Abstract

The diagnosis of tracheobronchial foreign body (FB) aspiration in children is often delayed or overlooked. The aim of this study is to examine the causes of delay (>1 month) in the diagnosis and to study the complications of late presentation and their management. During the period between July 1993 and August 2002, 128 patients with suspected FB aspiration were admitted to KKUH, Riyadh, Saudi Arabia. Twenty-eight patients out of 128 patients presented late (>1 month). The medical records of those 28 patients were reviewed in respect to: history of FB aspiration, physical signs of symptoms, reason for delayed presentation, radiological investigation, complications and their management, and follow-up. There were 16 males and 12 females; the average age was 3.28 years (range 1--11 years). All of them experienced chronic cough at presentation. Thirteen (48 per cent) children had a history suggestive of FB aspiration. Seventeen (63 per cent) children presented with complications that included pneumonia (n=13), bronchiectasis (n=3), and bronchoesophageal fistula (n=1). The diagnostic delay was attributed to physician misdiagnosis (n=9), failure by parents to seek early medical advice (n=4), patients left against medical advice (n=1), and the cause of delay was unknown in the remaining 14 children. Rigid bronchoscopy was performed in all patients. FB was found in all cases except four. Complications were treated as follows: pneumonia with intravenous antibiotics, bronchiectasis conservatively and bronchoesophageal fistula repaired surgically. Follow-up ranged from 6 to 48 months. Diagnostic delay of tracheobronchial FB aspiration has significant morbidity in children. A high index of suspicion and early referral are essential in preventing such complications.

Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

“…The frequency of radiopaque foreign bodies is in agreement with data in the literature, (1,10,22,23) as does the frequency of normal X-ray results, (23,24) showing that X-rays might not be as conclusive regarding the diagnosis. (25) The predominant location of the foreign body was the right lung, as has been observed in other studies.…”

“…The localized inflammatory process can be explained by the fact that the predominant locations of the foreign bodies were the lung and trachea, whereas the laryngeal edema could be explained by the aspiration of fish bones and their location in the larynx. (1,2,10,21) In most cases, there were no complications related to the endoscopic examination. (1,22) The presence of mild glottic edema and small hemorrhages during the examination, typically excluded by other authors, (23,28) were included here.…”

“…(8) The sensitivity and specificity of this diagnostic method are 67% and 68%, respectively. (9)(10)(11)(12)(13) Localized hyperinflation in the affected lung is one of the most frequently observed alterations, being considered the classical abnormality. (7,14) However, most foreign bodies are radiotransparent, which makes bronchoscopy the procedure of choice for diagnostic confirmation and foreign body removal, especially in inconclusive clinical cases.…”

Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008

“…[20,21] Bonchial changes (thickening of bronchial wall, cartilage damage and fi brosis) appear when the retention of FBs is longer than 30 days. [22] We found previously the relationship between retention of FB and airway remodeling.…”

Endobronchial foreign body aspirations causing chronic cough and dyspnea

“…It has been reported that in 21.8% of the cases diagnosis was delayed longer than 30 days. [3] Diagnosis requires advanced methods in cases of aspiration disregard or unawareness. [4,5] Especially in the elderly and with delayed diagnosis of aspiration, severe complications such as shortness of breath, chronic cough, pneumonia, atelectasis can follow.…”