Tracheobronchial foreign body aspiration in childhood

In 224 patients aged 7 months to 14 years aspirated foreign bodies (FB) were extracted from the tracheobronchial system. Eighty-one percent of the children were younger than 3 years, 50% were in the second year of life. There were twice as many boys as girls. Sixty-seven percent of the FB were nuts, of these more than half were peanuts. Fifty-six percent of aspirated FB were localized in the right bronchial system, 39% in the left and 5% subglottic or tracheal. All FB could be removed by endoscopy under general anaesthesia with muscle relaxation. The development of an extraction technique without forceps (encasing) led to an easier way of removing crumbling FB, like nuts. Complications were rare, no postoperative tracheotomy was necessary, no cardiac arrest and no death occurred.The interval between aspiration and intervention was longer than 3 weeks in one-third of the cases; in some cases it was months or years with the consequence of chronic damage of the bronchial system or the lung. The possibilities of prevention appear to be limited; thus it is necessary to diminish the frequency of prolonged lodging of FB in the respiratory tract by considering aspiration early in the differential diagnosis of airway symptoms.Abbreviation FB foreign body Dedicated to Prof. Klaus Betke on the occasion of his 70th birthday     

Pneumopericardium as a complication of foreign body aspiration

A case of pneumopericardium in an infant complicating aspiration of a foreign body is reported. In addition to X-ray studies echocardiography is valuable for the control of the disease. The pathogenesis and the treatment are discussed and a short review of the literature is given.     

支气管异物住院儿童误诊下呼吸道感染的影响因素研究

目的 探讨将支气管异物误诊为下呼吸道感染的影响因素,为儿童支气管异物的及时诊治提供科学依据.方法 以湖南省儿童医院2002年1月至2006年12月期间有完整病案记录资料的445例0～12岁支气管异物住院患儿为研究对象,根据其病历资料,采用自拟问卷收集相关信息并进行回顾性分析.结果 年龄越大、有阵发性咳嗽症状者误诊为下呼吸道感染的可能性越小;转院患儿、伴随有发热症状不利于儿童支气管异物的诊断,误诊的可能性增大.结论 支气管异物误诊率高,应广泛开展伤害预防的健康教育,提高监护人和临床医师对支气管异物的警惕性,以降低儿童支气管异物的误诊率.     

Foreign body aspiration in childhood

We studied 149 children aged seven months to 13 years (mean age 2.9 +/- 0.2 years) who had aspirated foreign bodies for age, sex, and type of foreign body. Symptoms, physical findings, chest x-ray, and fluoroscopy were compared with different sites of enlodgement. Positive history was obtained in 135 (91%). In 133 children, the diagnosis was made on admission. Frequent symptoms were cough (80%) and cyanosis (27%) following aspiration, while prevalent emergency department symptoms were cough (33%) and dyspnea (30%). Common physical findings on admission were decreased breath sounds (65%), tachypnea (43%), and fever (36%). Admission chest radiographs revealed emphysema (43%) and infiltrates or atelectasis (29%). Forty-one children (27%) were asymptomatic, and 43 children had normal chest x-ray. Fluoroscopy showed inspiratory mediastinal shift in 57%. Bronchoscopy performed within 48 hours of admission was successful in removing the foreign material in 88% of the children. Food particles were the most common type of foreign body. Hoarseness and stridor were significantly more common in upper airway enlodgement (P less than 0.01). Decreased breath sounds were significantly more common among children with lower airway enlodgement (P less than 0.001). A delay in diagnosis of longer than three weeks was associated with equivocal history of aspiration (P less than 0.05), and with significantly more wheezing (P less than 0.02) and atelectasis (P less than 0.01). Our study reemphasizes the importance of integrating various diagnostic tools in order to accurately evaluate and manage these children.     

Mummified insect as foreign body in the respiratory tract

A case report of a child with a cockroach in bronchus is described.     

A foreign body in the oesophagus as a cause of respiratory distress

A foreign body in the oesophagus caused severe respiratory distress and stridor but without apparent dysphagia. If an earlier diagnosis had been made, it is probable that employed tracheostomy would not have been necessary.     

Foreign body aspiration in childhood]

Damage to the airways and lung parenchyma from aspiration is a common clinical problem with diagnostic and therapeutic challenges. The insult may be acute or chronic. The amount of concentration, chemical composition, and size of particles vary, and the lesion produced may be reversible or irreversible. Death may be immediate or late. Recovery may be complete, or crippling pulmonary disease may follow. In this review is reported on the aspiration of foreign bodies or liquids into the respiratory tract. Specialty: in infancy, esophageal foreign bodies may cause mainly respiratory symptoms. Adequate diagnosis and therapy are discussed.     

Pneumomediastinum caused by foreign body aspiration in children

In a retrospective review of 155 children with tracheobronchial foreign body aspiration (FBA), there were ten patients who had pneumomediastinum (PM) on an initial chest radiograph. Nine of ten presented with PM and one patient had PM noted after bronchoscopy. In a child less than two years of age with no history of trauma, the radiographic finding of PM should prompt further investigation for FBA.Presented at the RSNA, November 27–December 2, 1988, Chicago, IL, USA     

Acute pancreatitis from a duodenal foreign body in a child

A 14-month-old child was admitted to the hospital with acute pancreatitis, abdominal pain, and shock. An abdominal radiograph revealed a paper clip standing out at the duodenal level. The foreign body was removed by endoscopy, revealing an edematic and hemorrhagic duodenal papilla. The patient progressed favorably after the foreign body was removed. This observation underlines the necessity of digestive transit surveillance of a foreign body that has not been endoscopically removed and the relevancy of duodenal endoscopy for acute pancreatitis of indefinite etiology.     

Late presentation of tracheobronchial foreign body aspiration in children

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.     

Pneumomediastinum with subcutaneous emphysema following foreign body aspiration

Correspondence to: H. Goez     

Tracheal rupture: a rare complication related to foreign body aspiration

A one-year-old patient admitted following foreign body aspiration and referred following cardiopulmonary resuscitation in a local hospital was diagnosed to have tracheobronchial rupture. We first assumed puncture of the mucous membrane of the left main bronchus by the tip of the tube. Later, we thought that the rupture might have been caused by rigid bronchoscopy. Etiology and treatment are discussed and recent literature reviewed.     

Chronic foreign body aspiration diagnosed by lung scan.

The case of a two-year-old child with foreign body aspiration is presented. It was complicated by a delay in diagnosis and treatment. Lung scan was helpful in eventually establishing the diagnosis. Key points in the management of patients with foreign body aspiration are reviewed and pathophysiologic mechanisms are discussed.