Foreign body aspiration in children: The value of diagnostic criteria

Objective

Foreign body aspiration (FBA) is a serious problem in children. While bronchoscopy should be performed in all patients with aspiration; patients without aspiration should be carefully excluded to avoid an unnecessary bronchoscopy. In this study we analyzed the details of our series, complication rates and compared the diagnostic findings between patients with an aspirated FB and those without. We also calculated the sensitivities, specificities, positive predictive values and negative predictive values of clinical history, symptoms, physical examination findings and radiological findings in patients with suspected FBA (sFBA). Finally, we evaluated the validity of our bronchoscopy indications in these patients.

Methods

We reviewed the data of 207 patients who underwent rigid bronchoscopy for sFBA. We used clinical history, symptoms, physical examination and radiological findings as diagnostic findings. Complication rates in addition to these four diagnostic criteria constitute our indications for performing a rigid bronchoscopy.

Results

After excluding 15 patients with radiopaque FB or previous fiberoptic bronchoscopy, 138 of 192 patients had an aspirated foreign body. The sensitivity and specificity of clinical history, symptoms, physical examination findings and radiological findings were 90.5% and 24.1%, 97.8% and 7.4%, 96.4% and 46.3, and 71.7% and 74.1% respectively. There was only one major complication which caused moderate neurological sequelae. There was no mortality and no thoracotomy or tracheotomy requirement in this group.

Conclusions

While symptoms, physical examination findings and clinical history had high sensitivities, radiological findings had the highest specificity. Low specificities of clinical history, symptoms and physical examination findings were due to our expanded bronchoscopy indication, which aimed to include all patients with foreign body aspiration. Our low complication rate facilitated the expansion of bronchoscopy indications, even for patients with slight clinical suspicion.     

Foreign body in tracheobronchial tree

Inhalation of foreign body into the tracheobronchial tree is a medical emergency sometimes resulting into sudden death. The current mortality rate due to foreign body inhalation ranges from 0% to 1.8%. Children with or without positive history of aspiration were examined and diagnosis was made on the basis of history, clinical findings, radiological evaluation and strong index of suspicion. A review of 30 cases of suspected foreign body aspiration revealed, children between 6 months were found to be very vulnerable to aspiration. Majority of children were boys. 80% of the patients had positive history of inhalation. Only 50% of the patients presented immediately i.e. within 24 hours after aspiration. Common symptoms were cough and respiratory distress. Decreased air entry was the significant clinical sign (50%). Obstructive emphysema and mediastinal shift were found in the majority of cases (50%). Rigid bronchoscopy under general anaesthesia and patient ventilating using a jet ventilator is a very safe and effective technique.     

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children.

OBJECTIVES: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.     

误诊为肺炎的小儿气管支气管异物的诊治

目的：分析小儿气管、支气管异物误诊为肺炎的原因，提高诊治水平，降低误诊率。方法：对67例误诊为肺部感染的气管、支气管异物患儿的临床资料进行回顾性分析；67例均在全身麻醉下行气管或支气管异物取出术。结果：63例（94％）均1次取出异物，4例（6％）经2次取出；无一例行气管切开及病例死亡。结论：提高对气管、支气管异物的认识及诊断水平是降低误诊率的关键，全身麻醉下硬管支气管镜检是取出气管、支气管异物的主要方法。     

Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms

BACKGROUND: Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay. OBJECTIVES: To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis. METHODS: We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed. RESULTS: During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis. CONCLUSIONS: Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.     

3D images based on MDCT in evaluation of patients with suspected foreign body aspiration

To evaluate the value of 3D images based on multi-detect computer tomography (MDCT) for the diagnosis and management of patients with suspected foreign bodies aspiration, and report our experience about diagnosis and management of the aforementioned patients using the 3D images, as well as detail our protocol for the management of those patients. Forty-four patients (37 children, 7 adults) with suspected foreign bodies aspiration who accepted pre-surgical examination and bronchoscopy in our hospital were included in this study. All the patients’ pre-surgical 3D images based on MDCT were reconstructed and analyzed. After that all the results were compared with observations in the surgeries. Among the 37 pediatrics, 34 patients were detected with FB in their tracheobronchial system by the 3D images based on MDCT, and 3 cases were detected negative. The sensitivity of 3D images is 100 %, and the specificity is 75 %.In the adult group, all the 7 cases of FB in the tracheobronchial tree were detected by 3D images and proved by bronchoscopy. 3D images based on MDCT were proved to be a valuable method for the diagnosis of the patients with suspected FB aspiration. In the diagnosis and management of those patients, we considered that both the typical FB aspiration history and the intractable symptoms of cough should be taken as the criteria and the first step for selecting those suspected patients; then 3D images based on MDCT could be taken as the second step and as the selective criteria for those patients who should accept the rigid bronchoscopy.     

Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis?

Clin. Otolaryngol. 2010, 35 , 479–485 Objectives: To evaluate the yield of clinical and radiological features in the diagnosis of suspected foreign body aspiration in children and to assess factors associated with delayed diagnosis of foreign body aspiration. Study design and setting: Retrospective review of 10 years of experience in tertiary referral centre. Participants: Data were extracted from clinical records of children who underwent rigid bronchoscopy for suspected foreign body aspiration at the University of Nigeria Teaching Hospital Enugu from 2000 to 2009. Main outcome measures: Clinical features and radiological findings were validated against bronchoscopic findings. Results: Data of 103 children, (mean = 2.7 years, range =7 months to 14 years; 64% boys and 36% girls, were analysed. Majority (73%) were under 3 years of age. Foreign body aspiration was proven bronchoscopically in 85 (83%) patients. The most common symptoms were sudden choking crisis (74%) and paroxysms of cough (73%). Independent predictors of proven foreign body aspiration were witnessed aspiration, choking crisis and unilateral decreased breath sounds in univariate (P = 0.001, <0.001, and 0.001 respectively) and multivariable analyses (P = 0.02, 0.001, and <0.001 respectively). The most sensitive and specific clinical features were choking (86%) and witnessed aspiration episode (89%), respectively. Available chest radiographs revealed radio-opaque objects in 27% of patients. Delayed diagnosis of foreign body aspiration (>72 h) was significantly more in younger children (t = 3.29; P = 0.001), as well as in children with no history of witnessed aspiration, negative chest examination and radiological signs (P < 0.001, P = 0.02 and P = 0.04 respectively). Conclusion: To prevent the delayed diagnosis, witnessed aspiration, choking crisis, unilateral decreased breath sounds and radiopaque objects should be checked in all suspected cases. When history is doubtful, regardless of radiological findings, bronchoscopy can be strongly recommended in the presence of two factors.     

What is the diagnostic value of flexible bronchoscopy in the initial investigation of children with suspected foreign body aspiration?

PURPOSE OF THE STUDY: The diagnosis and early bronchoscopic extraction of a foreign body (Fb) in children are life-saving measures. Many studies have described the manifestation of foreign body aspiration (FbA); however, only a few analyzed the role of flexible bronchoscopy in the diagnosis of FbA. The aim of this work is to define the indications of flexible bronchoscopy in the management algorithm of suspected FbA. SETTING: This study was conducted at a tertiary referral University Medical Center with an outpatient clinic and a 20-bed pediatric emergency unit. MATERIAL AND METHODS: Between January 2002 and July 2006 children referred with suspected FbA were included in this prospective study. Children with asphyxiating FbA requiring immediate rigid bronchoscopy, were excluded. If there was no convincing evidence of FbA, a diagnostic flexible bronchoscopy was performed under local anesthesia. In the case where a Fb was actually found, extraction was always performed by rigid bronchoscopy. RESULTS: Seventy cases (median age: 2 years, males: 44/females: 26) were analyzed. Among the 19 children who underwent flexible bronchoscopy first, 7 (37%) had a Fb. Among the 51 who underwent rigid bronchoscopy first, 43 had a Fb and 8 (16%) had a negative first rigid bronchoscopy. Predictive signs of a bronchial Fb were a radiopaque Fb, foreign body aspiration syndrome (FbAS) associated with unilaterally decreased breath sounds or localized wheezing and obstructive emphysema or atelectasis. CONCLUSION: In case of suspected FbA in children, the following management algorithm is suggested: rigid bronchoscopy should be performed solely in case of asphyxia, finding of a radiopaque Fb, or in the presence FbAS associated with unilaterally decreased breath sounds, localized wheezing and obstructive radiological emphysema, or atelectasis. In all other cases, flexible bronchoscopy should be performed first for diagnostic purposes.     

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Objectives

Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives.

Methods

We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy.

Results

Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB.

Conclusions

Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.     

Rigid bronchoscopy for the suspicion of foreign body in the airway

OBJECTIVE: Airway foreign bodies present a diagnostic dilemma and has been recognized for many years. Since aspiration of foreign bodies can be a serious and sometimes fatal problem, early intervention and proper management is vital. METHOD: In this retrospective study, the results of 1887 bronchoscopies, which were performed between the years 1973 and 2004 for the suspicion of foreign body aspiration in children, were presented. Various instruments and techniques were used over 31-year period and rigid bronchoscopy was the preferred method of foreign body extraction. RESULTS: There were 1106 boys and 781 girls with the median age of 2.3 years. Seventy-four percent of patients were less than 3 years old. The most common type of foreign body (89.9%) was organic; watermelon seeds (39.7%) were the most frequent organic foreign bodies. Eight hundred and twenty-three patients (43.6%) were referred to our clinic within the first 24h of the event while 4.5% of the patients were admitted to the hospital with the suspicion of foreign body in the airway later than one month. At bronchoscopy, a foreign body was identified in 79.1% of patients and no foreign body was seen in 20.9% of patients. Foreign bodies were encountered in 96.3% of the patients with positive history whereas 28.1% of the patients with negative history had foreign body. Of the patients with foreign bodies, 93.2% had positive history. Overall, the positive history was obtained from 85.2% of patients. The incidence of postbronchoscopic tracheotomy, thoracotomy, and overall mortality rate were 0.47, 0.15, and 0.21%, respectively. CONCLUSION: Otolaryngologists should consider foreign body aspiration in the airway in the differential diagnosis of any patient with the complaints of stridor, dyspnea, sudden onset of cough and intractable and recurrent lower respiratory tract infections. A careful history and physical examination were strong indicators of the diagnosis and raised the index of suspicion of an aspirated foreign body. Timely intervention with the experienced surgical team would decrease the complication rate and mortality rate. However, prevention of aspiration with the education of parents and caregivers is very important.     

Delayed diagnosis and treatment of foreign body aspiration in China: The roles played by physician inexperience and lack of bronchoscopy facilities at local treatment centers

Objective

We examined if lack of on-site bronchoscopy facilities and the inexperience of initial treating physicians contributed to missed or delayed diagnosis of tracheobronchial foreign body aspiration (FBA) in pediatric patients presenting with respiratory distress.

Methods

The medical records of 340 patients examined by bronchoscopy in our otolaryngology department from January 2009 to August 2012 were reviewed. Age, gender, clinical history, findings on physical examination, facilities at the initial treatment site (bronchoscopy or not), bronchoscopic findings (type and location of the FB), and initial diagnosis, were examined in terms of the delay between initial treatment and bronchoscopy-based diagnosis of FBA.

Results

The vast majority of patients (324/340, 95.29%) were 3 years of age or younger and a foreign body was located in 309 (90.88%). Of these 340 cases, 261 had been referred from other facilities (76.76%) whereas 79 had come directly to our hospital (23.24%). The median delay between initial treatment and bronchoscopic diagnosis was significantly shorter in those treated initially in our institution compared to referrals (24 h [1 h to 60 days] vs. 168 h [1 h to 366 days]; P < 0.01). The initial diagnosis was FBA in 135/261 referral cases (51.72%), significantly lower than in cases first treated in our institution (69/79, 87.34%; P < 0.01). Foreign body aspiration was confirmed in 127/135 referral cases (94.07%) and 62/69 directly treated cases (89.86%) (χ² = 1.193, P > 0.05). Of the 126 referral cases diagnosed with other conditions before coming to our hospital, FBA was confirmed in 114. Complications were significantly less frequent in cases treated directly than in referrals (24/79, 30.38% vs. 155/261, 59.39%; P < 0.01).

Conclusions

Local treatment facilities, most lacking bronchoscopy facilities and physicians who were trained to recognize FBA, misdiagnosed at least 44% of patients with respiratory distress and this led to significant delays in treatment. Greater regional access to bronchoscopy and improved training of primary care physicians will enhance diagnostic accuracy and reduce treatment delays.     

Airway foreign bodies (FB): a 10-year review

A retrospective chart review of children who had airway foreign body removed via direct laryngoscopy and bronchoscopy (DLB) from 1987-1997 was conducted in Children's Hospital, Boston. Patient characteristics noted included age, sex, and clinical presentation. Pre-operative radiographic findings, reason for delay in evaluation, DLB findings, length of procedure, reason for repeat DLB, and types of foreign body etc. were recorded. Serious complications from aspirated foreign bodies such as severe airway obstruction and death tend to occur in infants and younger children because of their small airway size. A history compatible with foreign body aspiration dictates diagnostic endoscopy with or without radiologic confirmation. Chest and airway radiographs supplemented by fluoroscopy can increase the ratio of correct and early diagnosis. Fluoroscopy should be universally accepted as an initial diagnostic technique in airway foreign body evaluation. Fluoroscopy is not a worthwhile investigation if a preceeding chest radiograph suggests the presence of a foreign body. Long-standing airway foreign bodies are associated with considerable morbidity, and early diagnosis remains the key to successful and uncomplicated management of foreign body aspiration. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach.     

Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients

Bronchial foreign bodies (FB) in children are difficult to diagnose when there is no witness to the aspiration event. The experience with three-dimensional CT and virtual bronchoscopic reconstruction (3D-CTVB) was reviewed for the diagnosis of bronchial FB in pediatric patients in this study. A retrospective review of ten pediatric patients (M:F = 5:5) who underwent rigid bronchoscopy by one otolaryngologist for the impression of a bronchial FB, at a tertiary training hospital, from February 2006 to September 2010 is reported. All patients had a plain chest X-ray and 3D-CTVB. The physical, radiological and bronchoscopic findings of the patients were analyzed. The mean duration from the aspiration event to hospital evaluation was 7 days (0–21 days). Four patients (44%) had witnesses to the aspiration event. Hyperaeration of the affected lung was noted in nine patients (90%) on the plain chest X-ray. In all of the patients, the foreign body location, suspected on the preoperative 3D-CTVB, was consistent with the intra-operative bronchoscopic findings. All FBs were successfully removed by rigid bronchoscopy without any complications. In conclusion, the 3D-CTVB was a very safe and useful diagnostic modality for bronchial FBs. The findings of this study suggest that the 3D-CTVB should be considered for the diagnosis of all patients with suspected bronchial FBs.     

Headscarf pin,a sharp foreign body aspiration with particular clinical characteristics

The process of wearing head scarf is very complex; girls used to hold a number of pins in the mouth and utilize them one by one to fix the scarf. Loss of concentration results in pin aspiration. We presented our experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem. We reviewed the records of 73 patients who underwent bronchoscopy for scarf pin inhalation during the period from January 1995 to May 2009. The following data were collected, history of aspiration, time lag before presentation, symptoms and signs, radiological findings, bronchoscopic findings, number of repeated bronchoscopy, complications, need for thoracotomy and time of discharge. All patients were female, mean age 13.4 years. The time lag before admission was <12 h for 59 (81%) patients. Positive history was present in all cases. Chest radiography identified the pins in all cases. The foreign bodies were seen in the left bronchial system in 37 (50.7%) patients, in the right bronchial system in another 24 (32.9%), and in the trachea in 12 (16.4%) patients. In 66 (90.4%) patients, the foreign body was removed in the first bronchoscopic trial; a second trial was needed in 5 (6.8%) patients, and thoracotomy was performed in two patients. In conclusion, head scarf pin aspiration occurs in adolescent Islamic girls. The clinical presentation and radiological findings are diagnostic in all cases. Rigid bronchoscopy is the preferred treatment modality. Health education is the key issue in the prevention of this problem.     

Airway foreign bodies in childhood

OBJECTIVE: To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications. METHODS: A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0+/-32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22, 相似文献   

Foreign body aspiration: clinical, radiological findings and factors associated with its late removal

OBJECTIVE: The study was carried out to assess the clinical and radiological findings and factors related to delay in definite diagnosis of foreign body aspiration and its removal. METHODS: Medical charts of 280 bronchoscopic-proven foreign body (FB) inhalators were reviewed. To analyze factors related to late removal, the population studied was divided into two groups according to time elapsed between injury and care-seeking (up to 24h and longer than 24h) followed by FB removal. RESULTS: Most children (69.5%) were under three, most were males (63.1%) and in 47.5%, rigid bronchoscopy was performed 24h after the accident. Organic foreign bodies were found in 63.4% of cases, most frequently peanuts (20.5%). Mortality related to FB aspiration reached 0.7%. In comparison with endoscopic diagnosis, clinical and radiological abnormalities were found in 99.3 and 84.3% (95% CI, 79.5-88.4%) of studied patients, respectively. The number of health services sought until definite diagnosis was the only factor associated with late removal (OR=23.0, 95% CI, 10.7-49.3%, p<0.001). CONCLUSION: The population studied presented a long delay in FB removal, thus demanding actions enhancing parent, physician and health services awareness, aiming at an earlier referral for diagnostic and therapeutic bronchoscopy.     

The causes and complications of late diagnosis of foreign body aspiration in children. Report of 210 cases

Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.     

小儿双侧支气管异物的临床特点及围手术期处理

目的 研究小儿双侧支气管异物的临床特点、诊断要点、围手术期处理技巧,减少漏诊、误诊,提高救治率,减少并发症的发生。方法 回顾性分析诊治的25例双侧支气管异物患儿的临床资料,对其临床特点、手术技巧及诊治原则进行总结。结果 25例中22例有明确异物吸入史,3例异物史不明确。术前22例患者完成64排螺旋CT三维成像(MDCT),其中10例显示双侧支气管异物,12例显示单侧支气管异物;另外3例患者病情较重考虑主气管异物直接急诊手术未做CT检查。手术均在全身麻醉下由经验丰富的医生实施硬质支气管镜取出,12例术前显示单侧支气管异物但术中为双侧支气管异物,可能与异物较碎、患儿剧烈咳嗽时引起异物变位有关,异物均取出顺利,无并发症发生。结论 双侧支气管异物具有病程短、临床症状重、出现呼吸困难时间短的特点,易误诊为单侧支气管或主气管异物。根据患儿有异物呛入后短时间内出现咳喘、呼吸困难进行性加重、听诊时双肺呼吸音相同程度或不同程度的减低及配合影像学检查可初步诊断是否为双侧支气管异物,一经诊断应尽快实施气管镜取出异物,减少死亡及并发症发生率。     

An overlooked bronchial foreign body in adult

A long-standing undiagnosed foreign body in bronchus in adult is very rare case. A 42 years old man with complain of chronic cough with expectoration and fever since 3 years was treated medically including a complete course of AKT for 6 months without improvement in the patient's condition. On taking detailed history, it was revealed that patient had swallowed or aspirated a denture before 3 years, which was overlooked by the treating clinicians. As denture is radiolucent foreign body it remained undiagnosed in X-ray chest for 3 years. It was visualized on flexible bronchoscopy and removed with rigid bronchoscopy. The patient got relieved from symptoms within a week. So presence of chronic cough. wheezing and fever without reduced air entry and without obstructive finding in X-ray chest, should indicate the need for diagnostic bronchoscopy. Also adult patients of recurrent lower respiratory symptoms in spite of satisfactory medical treatment must be submitted for diagnostic bronchoscopy.