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     

Impact of community educational programmes on foreign body aspiration in Israel

The study objectives were to determine the impact of a nation-wide educational campaign on the incidence of foreign body aspiration (FBA) in Israeli children. Impressed by the alarming number of FBAs, we conducted an educational campaign through the media during 1982–1983. The campaign included television and radio broadcasts, newspaper articles and interviews, and medical educational programmes in community paediatric care centres. Questionnaires were sent to all Departments of Paediatrics in Israel. Results showed a reduction in the incidence of FBA by 35% in 1983 as compared to 1981. Re-evaluation studies conducted in 1992 showed no further reduction of FBA.Conclusion Continuous and extensive educational programmes should be undertaken by the health authorities if FBA is to be prevented. Furthermore, it is important to legislate mandatory labelling of seed and nut containers with the warning that the intake of seeds is dangerous to children under 5 years of age.     

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.     

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.     

Spontaneous expulsion of unusual tracheobronchial foreign body

An extremely rare case of long, thin and sharp pin in a young boy which was inhaled initially and defied removal at branchoscopy was eventually recovered in stool after a long and variable course through alimentary tract has been reported.     

Management of tracheobronchial foreign body in children

To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at S?o Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.     

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 body aspiration in children

BACKGROUND: The aim was to investigate the role of physical and radiological findings before bronchoscopy in the diagnosis of foreign body aspiration (FBA). METHODS: We retrospectively reviewed the clinical records for 82 patients (mean age 26.4 +/- 21.4 months, range 9 months to 13.5 years; 49 males) with a history suggestive of foreign body aspiration. RESULTS: The presence of a foreign body in the airways was confirmed in 70 children (85.4%) (mean age 25 +/- 14.1 months, 45 boys). Of the 70 children, 63 patients (90%) were under 3 years of age, with a peak incidence during the second year. Of the 70 foreign bodies retrieved, 46 (60%) were vegetable and 35 (76%) of these were nuts. In 42% of the patients the foreign body was located in the right bronchial tree. The most frequent physical findings observed in our patients were persistent cough (75%), localized decreased breath sound (62.8%) and localized wheezing (30%). The clinical triad (concomitant cough, localized wheezing and decreased breath sound) was present in 11 patients (15.7%). All clinical findings had a high positive predictive value with poor sensitivity. In 11 patients (20%) chest X-rays were normal. Five foreign bodies (9.1%) were radiopaque. The most frequent radiological findings observed were localized air trapping (43.6%), followed by atelectasis (40%). The diagnostic sensitivity was 80% and the specificity 33% for the presence of a single positive radiological finding. CONCLUSIONS: Our study confirmed that clinical symptoms and radiological findings before bronchoscopy have a low diagnostic value in children with a history of FBA.     

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.     

Foreign body aspiration in children

Foreign body aspiration is a common accident in children and represents an important cause of morbidity and mortality. Diagnosis of this condition demands a high degree of suspicion since physical examination and basic radiology exams have low sensitivity. It is more frequent in children younger than 3 years of age, predominantly boys. Food materials are most commonly involved, particularly peanuts, although this could change according to regional feeding habits. The right main bronchus is the site where foreign bodies are most commonly found. Radiographical findings are not diagnostic, but the presence of unilateral obstructive emphysema or atelectasis are important clues. A rigid endoscopy is indicated whenever there is a suggestive history, since delays in removing foreign bodies can lead to severe bronchial sequelae. In developing countries this type of accident may be more relevant due to the lack of resources and awareness, which can lead to late diagnosis and treatment. Routine preventive measures must be taught to caregivers in order to reduce the incidence. Health care professionals should also be made more aware of the prevalence of this condition.     

Spiral computed tomography with 3-dimensional reconstruction for the diagnosis of tracheobronchial stenosis

We report on the usefulness of spiral computed tomography (CT) with 3-dimensional (3D) reconstruction in the diagnosis of tracheobronchial abnormalities based on three cases of children with congenital tracheobronchial strictures. Images were reconstructed using a curved planar reformat and shaded surface display. The images obtained from our three cases of tracheal stenosis, subglottic stenosis and tracheobronchial strictures were extremely clear. Spiral CT with 3D reconstruction provides excellent anatomic delineation of the tracheobronchial airway, and is safe and less invasive than tracheobronchography.     

Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration

Background Foreign body aspiration is common in children, especially those under 3 years of age. Chest radiography and CT are the main imaging modalities for the evaluation of these children. Management of children with suspected foreign body aspiration (SFBA) mainly depends on radiological findings. Objective To investigate the potential use of low-dose multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation and management of SFBA in children. Materials and methods Included in the study were 37 children (17 girls, 20 boys; age 4 months to 10 years, mean 32 months) with SFBA. Chest radiographs were obtained prior to MDCT in all patients. MDCT was performed using a low-dose technique. VB images were obtained in the same session. Conventional bronchoscopy (CB) was performed within 24 h on patients in whom an obstructive abnormality had been found by MDCT and VB. Results Obstructive pathology was found in 16 (43.25%) of the 37 patients using MDCT and VB. In 13 of these patients, foreign bodies were detected and removed via CB. The foreign bodies were located in the right main bronchus (n = 5), in the bronchus intermedius (n = 6), in the medial segment of the middle lobe bronchus (n = 1), and in the left main bronchus (n = 1). In the remaining three patients, the diagnosis was false-positive for an obstructive pathology by MDCT and VB; the final diagnoses were secretions (n = 2) and schwannoma (n = 1), as demonstrated by CB. In 21 patients in whom no obstructive pathology was detected by MDCT and VB, CB was not performed. These patients were followed for 5–20 months without any recurrent obstructive symptomatology. Conclusions Low-dose MDCT and VB are non-invasive radiological modalities that can be used easily in the investigation of SFBA in children. MDCT and VB provide the exact location of the obstructive pathology prior to CB. If obstructive pathology is depicted with MDCT and VB, CB should be performed either for confirmation of the diagnosis or for the diagnosis of an alternative cause for the obstruction. In cases where no obstructive pathology is detected by MDCT and VB, CB may not be clinically useful.     

Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children

Background: A significant proportion of cases of tracheobronchial foreign body aspiration due to life‐threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature. Methods: One hundred and eighty‐four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used. Results: The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X‐ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin. Conclusions: Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.     

Hepatic foreign body in a child

The majority of foreign bodies (FBs) swallowed by children are passed spontaneously without event. Perforation of the intestine with migration to the liver is rare. A child with a needle in the right lobe of the liver is reported.     

Foreign body aspiration in children: Field report of a German hospital

Background: The aspiration of foreign bodies (FB), especially by small children, is a life‐threatening situation and can be fatal. The aim of this survey was to study the types of foreign bodies in the upper airways and digestive tract, and the circumstances leading to the aspiration on the basis of hospital records of the Berlin University Hospital in Germany from 1997–2002. Methods: We performed a retrospective review of hospital records using a standardized protocol. Foreign body aspiration that occurred in children aged 0–14 were considered for inclusion in the database. During the study period, 78 patients with a diagnosis of FB were included in the database. Forty‐five patients were male and 33 were female. The median age was 1. Results: In 89.5% of all cases, the children were under the age of 3. Seventy‐five of the 78 patients had a foreign body in the trachea/bronchial trees/lungs based on International Classification of Diseases‐9 codes at the time of discharge. At the time the injury occurred, the children had either been eating (41.1%) or playing (50.0%). More than 50% of the children were being supervised by an adult at the time the injury occurred. The foreign bodies (FB) were always extracted by using an endoscopic procedure (n= 43 rigid, n= 6 flexible and n= 29 combination of both methods). Moreover, hospitalization was always required due to an institutional requirement. The most commonly found foreign bodies were seeds, nuts, berries and grains. Conclusion: Most of the foreign bodies were found in the bronchial tubes, trachea, and lungs. The extraction method from these areas is rigid and/or flexible bronchoscopy or gastrointestinal endoscopy, a procedure requiring anesthesia. There seems to be no association between the aspirated foreign bodies and other purchased objects or packaging material. The fact that a large fraction of the injuries occur under the supervision of the adults suggests that the number and severity of the injuries could be reduced by educating parents and children. Our experience confirms, therefore, that further research into the behavioral aspects leading to FB injuries is needed.     

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     

CT virtual bronchoscopy: New non invasive tool in pediatric patients with foreign body aspiration

A 2-year-old girl presented with recurrent cough, wheese and breathing difficulty. Her imaging (CT and virtual bronchoscopy) revealed a foreign body in tracheobronchial tree, that was removed by rigid bronchoscopy.     

H-type tracheo-oesophageal fistula: appearance on three-dimensional computed tomography and virtual bronchoscopy

H-type tracheo-oesophageal fistula (TOF) is a rare type of fistula without oesophageal atresia. The symptoms are usually present at birth, but the diagnosis is often delayed. Traditionally, contrast oesophagography and/or fiberoptic bronchoscopy are used to confirm the diagnosis. We describe the imaging features of a case of H-type TOF seen on three-dimensional computed tomography and virtual bronchoscopy and the usefulness of these techniques in pre-operative evaluation. Accepted: 11 August 2000     

肺CT在诊断和治疗小儿气管、支气管异物中的价值

Objective The purpose of this study was to investigate the value of chest CT in the evaluation ofchildren with suspected foreign body aspiration. Methods Chest CT was performed in 45consecutive children with suspected foreign body aspiration. The patients were examined with 16-slice Multidetector CT (MDCT) using 100 ～ 150 kV,30 ～ 50 mA, 1 mm section thickness. 1.2 pitch ratio, and 0.6 ～1.0 mm reconstruction interval. multiplanar reformatted (MPR) imaging were carried out after MDCT examinations. Results Chest CT revealed all foreign bodies in 42 of the 45 patients. Three patients with suspected foreign body aspiration did not show evidence of foreign body on CT,and they were treated with antibiotics for one week. These patients avoided unnecessary operations and recovered completely. The other 42 patients had evidence of foreign bodies in their bronchi. We designed the surgerical plan and selected appropriate foreign body forceps based on the CT scans. All of the 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. Conclusion The diagnosis of foreign body aspiration of the airwayin children can be accomplished by using chest 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.     

�������CT�;��ض�ά�����Ķ�ͼ���

目的探讨多层螺旋CT(MSCT)及联合经胸二维超声心动图(TTE)检查在先天性心脏病诊断中的意义。方法收集广东省心血管病研究所自2002年9月至2003年12月间86例儿童先天性心脏病病例,全部患儿接受了MSCT和TTE检查,12例接受心导管检查,其中69例进行了外科手术,将术前MSCT、TTE和心导管检查结果分别与手术诊断进行比较。结果69例患儿共计有129处畸形,TTE正确诊断116处(89.9%),MSCT正确诊断112处畸形(86.8%),两者联合正确诊断127处畸形(98.4%),12例心导管检查未能提供更有价值的资料。结论MSCT对先天性心脏病诊断具有较高的价值,尤其是联合TTE可取代部分心导管检查为外科手术提供正确和充分的术前诊断。对于年龄小或重症不耐受心导管检查的患儿具有更大的意义。