Non-asphyxiating tracheobronchial foreign bodies in adults

Abstract

The presentations of 47 adult patients with a non-asphyxiating tracheobronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine ("acute group"); 1 month or more in 29 ("chronic group"), uncertain in four ("uncertain group"); and the foreign body was a broncholith in five patients ("broncholith group"). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient. Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients. The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to "suspicion of an endobronchial lesion" were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.

Removal of Tracheobronchial Foreign Bodies in Adults Using a Flexible Bronchoscope: Experience with 200 Cases in China

“…These findings were consistent with previous Chinese or south Asian studies (6)(7)(8), and are related to the local eating habits and customs. However, there were differences between the different age groups.…”

“…The present study consisted of 200 adult Chinese patients with FBs who were treated in the past 10 years. The age and sex distributions were similar to those in the previous studies (3,(5)(6)(7)(8)(9)(10).…”

“…The extraction of FBs using a flexible bronchoscope is one of the most commonly used techniques (3,6,7). A few published studies have described the clinical features and endoscopic management of tracheobronchial FBs (2,3,(5)(6)(7)(8)(9)(10). However, the sample sizes of these studies were small, and few of them reported the management of the complications of FBs aspiration.…”

Unintentional although providential iodinated contrast

“…1 a Scout view shows a round radio-opaque image projected near the carina. CT thorax scan in axial plane (b), reformatted in coronal plane (c, d) with mediastinum (c) and lung (d) window, demonstrates a high-density endobronchial foreign body at the origin of right main bronchus habits, most foreign bodies in children and in adults are organic in nature [5,9,10]. Symptoms associated with the aspiration of a foreign body are heterogeneous, and may range from acute asphyxiation with or without complete airway obstruction, to stridor, dysphonia, cough, dyspnea, or fever, therefore mimicking many other medical conditions presenting with breathing abnormalities [9,11].…”

“…The delay in diagnosis has been described to range from a few hours to some months, and the mean delay seems to be longer in adults than in children [5]. Serious sequels such as pneumonia (with delayed resolution or recurrent in the same areas), pulmonary atelectasis, bronchiectasis [8,10] or chronic cough [13] may occur in cases of delay in diagnosis.…”