Value of chest CT in the diagnosis and management of tracheobronchial foreign bodies

Background: The aim of the present study was to investigate the value of chest multidetector computed tomography (CT) in the evaluation of children with suspected foreign body aspiration. Methods: Chest CT was performed in 45 consecutive children with suspected foreign body aspiration, and plain chest X‐ray was conducted at the same time. Multiplanar reformatted imaging was carried out after multidetector CT. Rigid bronchoscopy and removal of the foreign body was performed under general anesthesia. Results: All 42 patients (100%) with tracheobronchial foreign bodies were identified on chest CT. Three patients avoided unnecessary operations due to negative CT scans. For the patients with tracheobronchial foreign bodies, the occurrence of unilateral hyperlucent lung and post‐obstructive lobar or segmental infiltrates on plain chest X‐ray was 42.9% (18/42) and 4.8% (2/42), respectively. Twenty‐two of the 42 patients (52.4%) had no abnormalities on plain X‐ray. The difference between multidetector CT and plain X‐ray results was statistically significant (P < 0.001). Surgical plans were designed and appropriate foreign body forceps were selected based on the CT scans. All foreign bodies were removed successfully, and no severe complications were observed. The location, shape, and volume of the foreign bodies found at surgery were consistent with the CT images. Conclusions: The diagnosis of foreign body aspiration of the airway in children can be accomplished by using chest multidetector CT. It is often useful in delineating the exact shape, location, volume and form of a bronchial foreign body and can help the surgeon plan for operative bronchoscopy and safe removal of the foreign body.     

Foreign bodies in the pediatric airway

In a review of 34 children with foreign bodies in the airway, between 1978 and 1982,24 were males and 10 females. Eighteen of them were between one and two years of age. Vegetable matter was the causative agent in 76–47 percent with 47.06 percent due to a portion of groundnut A history of foreign body aspiration was obtained in 24 patients and obstructive emphysema demonstrated on plain X-ray of the chest in 21 patients. Radioopaque foreign bodies were seen in only 6 patients. Foreign bodies were seen with almost equal frequency on both sides, 13 in the right bronchus and 14 in the left bronchus. All patients had their foreign bodies removed-one through the endotracheal tube, 29 bronchoscopically. 2 by tracheotomy and 2 by bronchotomy. There was no mortality. The details of the diverse clinical presentations, findings and method of treatment are also discussed.     

Late migration of a foreign body in the foot 5 years after initial trauma

An 11-year-old boy presented to our emergency department because of the extrusion of a small piece of glass through the plantar skin, 5 years after the initial trauma. Another foreign body was identified on ultrasounds and removed surgically. Ultrasound is an accurate test for detection of foreign bodies and to assess potential complications. The treatment of all foreign bodies is surgical exploration and removal, except if the risks of attempting removal are higher than the potential damage of the foreign body in its existing location. Migrations of foreign bodies are not uncommon. Ultrasounds could help for localization and removal as an intraoperative procedure. In case of suspicion of a foreign body after trauma, complementary examinations are required.     

The radiolucent wooden foreign body.

Wooden foreign bodies in the extremities are frequently not suspected at initial presentation. Most often, these foreign bodies are not visualized radiographically. Xeroradiography, ultrasound, computed tomography, and MRI have been described as useful adjuncts in foreign body detection and localization. In our case, a truly radiolucent wooden foreign body was well visualized on plain radiographs. The atypical appearance resulted in misinterpretation, and proper diagnosis and treatment were delayed.     

Esophageal and tracheobronchial foreign bodies in infants and children

In an effort to improve the diagnosis and management of children with aspiration or ingestion of foreign bodies we reviewed 100 consecutive cases of esophageal (49) or tracheobronchial (51) foreign bodies occurring over a 6-year period. While the incidence of positive physical findings in the esophageal group was low, the combination of plain and contrast radiography was positive in 96% (47/49). Of the patients with tracheobronchial foreign body, 78% (40/51) had lateralizing signs on physical examination and 80% (41/51) had abnormal inspiratory/expiratory radiographs. Disimpaction of esophageal foreign bodies was carried out using a combination of techniques with 100% success and no complications. All cases of tracheobronchial foreign bodies were managed with the rigid bronchoscope with 98% success (50/51) using a variety of instruments. Complications secondary to the foreign body itself rather than its management were seen in 9 patients, and were often due to a delay in diagnosis. A careful history and physical examination along with appropriate radiographic studies will result in a correct diagnosis in virtually all cases of esophageal and tracheobronchial foreign bodies. A liberal indication for endoscopy using an approach tailored to the particular case will almost always be successful. Offprint requests to: J. R. Wesley     

Chronic brain abscess secondary to a retained wooden foreign body: Diagnostic and management dilemmas

A four-year-old child presented with recent onset generalized tonic clonic seizures. She was operated for a suspected intracranial tuberculoma and was found to harbor an intra-parenchymal retained wooden foreign body with a chronic abscess. The foreign body had entered the brain parenchyma after a minor head injury, sustained three years earlier. She was asymptomatic for the intervening three years. The initial diagnosis was missed by several physicians. A retained wooden fragment via a transtemporal apparently closed head injury is an extremely rare event. The present study reveals the diagnostic and therapeutic challenges and stresses the importance of high degree of suspicion to diagnose retained intracranial foreign bodies and the need for early surgical exploration, to avoid chronic and potentially life threatening neurological complications.     

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??Objective??To analyze the clinical value of rigid esophageal endoscopy in treatment with esophageal foreign bodies in children. Methods??A total of 186 pediatric patients with esophageal foreign bodies in Children’s Hospital of Nanjing Medical University from April 2016 to June 2017 were identified. A repeat chest X-ray was performed??children with esophageal foreign body did not pass through the esophagus were taken to rigid endoscopy under general anesthesia. Results??Foreign bodies passed through esophagus and been eliminated out of body in 37 cases??one was removed out by flexible endoscopy??one was vomited out spontaneously. 148 cases were taken to rigid esophageal endoscopy under general anesthesia. Foreign bodies were successfully removed out from 144 cases??no foreign body was found in 2 cases??foreign bodies dropped into the lower digestive tract during operation in 2 cases. Conclusion??Rigid esophageal endoscopy is great helpful in the treatment with esophageal foreign bodies in children.     

The toothbrush: a rare but potentially life-threatening cause of penetrating oropharyngeal trauma in children

We present the case of a 10-year-old girl with pharyngeal injury caused by a toothbrush, the snapped head of which lodged in her upper oropharyngeal wall. Initial examination of the oral cavity did not reveal bleeding, a foreign body, or a wound. Nasopharyngoscopy showed lodgment of the toothbrush piece in the upper oropharynx, pulsating in synchrony with heartbeats. Computed tomography showed the toothbrush head near the carotid artery. The foreign body was surgically removed without any intraoperative or postoperative complications. The diagnosis and management of oropharyngeal injuries by stick-like foreign bodies, such as a toothbrush or chopsticks, are discussed.     

小儿泌尿生殖系统异物32例临床分析

目的 总结泌尿生殖道异物患儿的诊疗经验.方法 回顾性分析1992年4月至2013年5月我们收治的泌尿生殖系统异物患儿临床资料.共32例（男15例,女17例）患儿,平均年龄7.9岁.异物位于膀胱7例,阴道15例,尿道8例,阴茎根部皮下1例,阴囊内1例.异物种类多样,进入体内方式以患儿自行置入最常见（28例,87.5%）,存留时间最短半天,最长逾1年.经X线摄片诊断12例,B超或联合摄片诊断10例,CT/MRI或联合B超诊断7例,体查诊断2例,内镜检查诊断1例.结果 所有患儿均完整取出异物,治愈出院,随访期内正常排尿.结论 X线摄片及B超为诊断的首选方法,联合CT或内镜检查可有效提高诊断率.临床确诊或高度怀疑泌尿生殖系统异物的患儿应尽早手术,需根据异物的种类、位置及感染情况选择不同的手术方法,内镜为首选,开放手术亦为有效的治疗方式.加强对儿童的看护、教育,正确引导儿童的好奇心,可以预防泌尿生殖道异物.     

Foreign bodies in the tracheobronchial tree: a review of 102 cases in Benghazi, Libya

A total of 102 children in whom foreign body aspiration was suspected were admitted to hospital and their records reviewed. Bronchoscopy was performed on all except two who coughed out the foreign body. In 76 cases (group A), foreign bodies were identified in the tracheobronchial tree. In the remaining 26 (group B), no foreign body was found. Boys predominated over girls. Most of the foreign bodies were lodged on the right side. The commonest foreign body was the peanut. Clinical and radiological features in group A were not diagnostic; in many instances, therefore, the threshold of suspicion of aspiration should be low. Hence, medical personnel and the public should be made more aware of this problem.     

Normal radiographic findings after foreign body aspiration. When the history counts

Foreign body aspiration in children is frequently associated with unilateral emphysema or atelectasis on chest x-ray. Two cases are reported of tracheal or bilateral foreign bodies in which the original chest x-rays were read as normal, but the history was suggestive of the foreign body aspiration. Early bronchoscopy can prevent the long-term morbidity that results from unrecognized tracheobronchial foreign bodies.     

Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency

Objective

Foreign body ingestion is a common problem for which children present to the emergency department. The most common ingested foreign bodies among children are coins. Metal detector is an equipment, which measures a change in inductance of a coil when an electroconductive material is placed near it and produces an audio-visual signal. The present study was conducted to determine the effectiveness and feasibility of HMD in the local Pediatric population.

Methods

This was a prospective study conducted in the pediatric emergency department among children presenting with history of foreign body ingestion. The outcome measured was presence or absence of metallic foreign body detected on handheld metal detector examination.

Results

During the study period, 36 patients with history of foreign body ingestion presented to the emergency department. Among these, 28 were metallic foreign body ingestions. Coins were the most common type of foreign body ingested. Among the metallic foreign bodies ingested, all the coins were accurately identified by the handheld metal detector. Non-coin metallic foreign bodies like metallic screw, needle and stapler pin were not identified by the handheld metal detector.

Conclusions

The study demonstrates that handheld metal detector can be safely and reliably used as a screening tool in the process of detecting ingested coins. The plain radiograph still appears to be superior as it accurately localizes sharp metallic objects as well as cell batteries (button batteries) which need to be detected early and removed in order to prevent complications. Handheld metal detector is an effective tool that can be used in the follow up of patients to confirm whether the coin like metallic foreign body has been expelled. Handheld metal detector examination is more sensitive than traditional X-ray examination to detect radiolucent metallic foreign bodies like aluminium.

     

儿童上消化道异物所致并发症及其危险因素分析

目的 探讨儿童上消化道异物引起的并发症及相关危险因素。方法 收集2014年1月至2018年12月门诊或住院治疗的上消化道异物患儿772例的临床资料进行分析,通过多因素logistic回归分析上消化道异物患儿发生并发症的危险因素。结果 772例患儿异物均由电子胃镜取出,男414例,女358例,中位年龄2.8岁。消化道异物主要发生在年龄 < 3岁婴幼儿组（59.5%）;异物主要分布于食管段（57.5%）和胃内（28.9%）;异物滞留时间≤24 h 465例（60.2%）, > 24 h 307例（39.8%）。异物的类型主要为圆形金属异物（37.2%）、长条形异物（24.7%）、尖锐异物（16.2%）、电池（14.4%）、腐蚀性物质（4.8%）和磁铁（2.7%）。根据并发症发生情况分为轻度并发症（368例,47.7%）、严重并发症（98例,12.7%）及无并发症（306例,39.6%）。经logistic回归分析结果显示,年龄 < 3岁、基础疾病、异物位置、异物类型、异物滞留时间 > 24 h是引起上消化道异物并发症发生的危险因素（分别OR=2.141、7.373、6.658、8.892、6.376,P < 0.05）。结论 通过对上述导致消化道异物并发症的高危因素地了解,在临床上及时准确地选择恰当的干预方式,可降低各类严重并发症的发生。     

肺CT在诊断和治疗小儿气管、支气管异物中的价值

目的 探讨肺CT在诊断和治疗小儿气管、支气管异物中的价值.方法 对怀疑气管、支气管异物的45例患儿进行肺CT检查,应用的是16层超薄CT扫描,条件为:100～150 kV,30～50 mA,层厚1 mm,CT扫描后进行多层CT影像重建.结果 45例患儿中有42例CT检查发现了异物,另外没发现异物的3例经抗生素对症治疗1周痊愈,避免了支气管镜检术.根据CT影像及异物特点,我们设计了手术方案并选择合适的异物钳,42例患儿均一次即将异物取出,肺CT所显示的异物位置、形状及体积与支气管镜检时所见基本一致.结论 应用肺CT可以准确地诊断出气管、支气管异物,CT所提示的异物位置、形状、体积对于设计手术方案和安全取出异物具有重要价值.     

Retained foreign body: associations with elevated lead levels,pica, and duodenal anomaly

A 14-month-old girl presented with elevated lead levels and a metallic foreign body was detected on abdominal radiograph. Subsequent evaluation, performed after the child failed to pass the foreign body with cathartics, revealed a bezoar proximal to a partial duodenal obstruction. The metallic foreign body was later removed and found to contain lead, however, the patient has subsequently had recurrent elevations of lead levels with episodes of pica. This case reiterates the need to evaluate children with retained foreign bodies for lead poisoning due to associated pica. In addition, retained foreign bodies should point to possible congenital anomaly of the duodenum causing partial obstruction.     

儿童气管支气管异物临床特征分析（附228例报告）

目的　探讨儿童气管支气管异物的临床特点、 诊治并分析气管内膜肉芽形成相关危险因素。 方法　回顾性分析2011年1月至2017年12月厦门大学附属第一医院儿科呼吸病房收治的228例确诊为气管支气管异物患儿的临床资料,并采用Logistic二元回归方法对气管支气管异物继发气道内膜肉芽形成的相关危险因素进行分析。结果　儿童气管支气管异物的高发年龄为1～3岁（76.3%）,男女比例为2.3∶1。其中植物性异物居多（82.9%）,异物好发部位左肺（52.6%）高于右肺（39.5%）。气管内膜肉芽形成（74.4%）、 肺炎（76.3%）、 肺气肿（51.3%）是气管支气管异物最常见的并发症。异物种类及异物残留时间是导致气管内膜肉芽形成的独立危险因素（P＜0.01）,病程越长,肉芽形成的风险越大（P＜0.01）。经受试者工作特征（ROC）曲线下面积计算得出,异物残留时间可作为判断是否合并气管内膜肉芽形成的可靠预测指标,诊断界值为≥7.5 d。228例（100%）均在局部麻醉下行纤维支气管镜异物术成功取出异物,226例为1次性取出（99.1%）,术中术后未出现明显并发症。结论　婴幼儿是气管支气管异物的高发人群,以植物性异物多见。植物类异物残留易造成气管内膜肉芽形成,病程越长,肉芽形成风险越高。应避免婴幼儿喂食坚果类食物,同时早期识别、 正确诊断并选用适宜的手术方式是预防异物吸入和治疗的关键。     

Aural foreign bodies in children

Objective Foreign body in the ear is commonly encountered in children by primary care givers, emergency department Physicians, Pediatricians and Otolaryngologists worldwide. Methods We reviewed cases of aural foreign bodies in children seen in our centre over a five-year period with the aim of auditing our current practice and suggesting possible improvements suited for developing countries. Results Grains and seeds (27.9%), beads (19.7%), cotton wool (13.6%), paper (8.8%) and eraser (8.2%) formed the bulk of the aural foreign bodies. About 96% was removed without general anesthesia by using Jobson Horne’s probe or aural dressing forceps (73.8%) under direct vision; or by syringing (22.1%). Some 4% had to be removed in the operating theatre under general anesthesia. The complications observed include bruise or laceration and bleeding from the external auditory canal (16.3%), otitis externa (6.5%) and traumatic perforation of the tympanic membrane (1.7%). Conclusion Despite a high proportion of cases managed in the office setting, complication rates were within acceptable levels. There is need to develop practical criteria that will be beneficial to primary health care givers to determine which patients could be managed in the primary care setting with acceptable outcome.     

"I can't taste ice cream": an unusual case of tinnitus and dysgeusia

Auricular foreign bodies are usually presented to the emergency department in an easily recognizable fashion. We report the case of a 16-year-old male who presented to the emergency department with complaints of unilateral tinnitus and dysgeusia. He denied any history of injury except for falling from his bike in the woods earlier that day. On examination, a wooden foreign body was found in the external auditory canal. A computed tomography scan revealed a 3-cm-long twig that pierced the middle ear disrupting the ossicles. He was taken to the operating room for removal and microscopic evaluation. On evaluation, the chorda tympani nerve was found to be severed along with disruption of the ossicles. This is an unusual presentation for an aural foreign body, and the resulting injury of the chorda tympani is not well published. One should consider the possibility of injury to the middle and inner ear and perform the necessary clinical evaluation before and after removal of aural foreign bodies.     

Gravel gut: small bowel perforation due to a blunt ingested foreign body

The ingestion of foreign bodies remains a common occurrence in children. Most ingested foreign bodies pass spontaneously, although up to 1% will result in intestinal perforation. Specific foreign bodies such as sharp, pointed, or corrosive objects have been typically associated with perforation. The initial diagnosis of foreign body ingestion may be difficult in the absence of a witness, and the presentation of perforation in this situation difficult to distinguish from other causes of an acute abdomen. We report a case of ileal perforation due to a blunt ingested foreign body in a child in whom the diagnosis was unclear until laparotomy. This case highlights the difficulties in managing pediatric ingested foreign bodies, including the risk of perforation even with a blunt object.     

Radiographic identification of ingested disc batteries

Recently, the hazards posed by the accidental ingestion and impaction of small disc batteries have been widely publicized in the medical and lay press. These foreign bodies, when lodged in the esophagus, leak a caustic solution of 26 to 45% sodium or potassium hydroxide which can cause a burn injury to the esophagus in a very short period of time. Because of the considerable clinical morbidity and mortality from this foreign body, it becomes imperative for the radiologist to quickly and accurately identify disc batteries on plain radiographs. This communication offers a series of radiologic signs important in the identification of disc batteries. When viewed in an anterior projection, disc batteries demonstrate a double density shadow due to the bilaminar structure of the battery. On lateral view, the edges of most disc batteries are round and again present a step-off at the junction of the cathode and anode. These findings are differentiated from the more common esophageal foreign body of a coin which does not have a double density on frontal projection, has a much sharper edge and no visible step-off.