Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995-2006
ABSTRACT Tracheobronchial foreign body (TFB) removal in adult patients using the combined technique of flexible bronchoscopy (FBSC) through the endotracheal tube as well as using the simple FBSC has not often been described. This study reports our experience with FBSC for removal of TFBs and describes diagnosis, techniques of removal, and types of TFBs.
We retrospectively examined bronchoscopic records of adult patients performed between 1995 and 2006 and collection of foreign bodies in Clinical Department for Respiratory Diseases, University Hospital Split, Croatia.
TFBs were found in 86 (0.33%) out of 26,124 patients who were submitted to bronchoscopy. The majority of the patients (90%) had some risk factor for aspiration, among which stroke (30%) was the most frequent. Patients with different neurologic and neuromuscular diseases together accounted for 58% of all patients with TFB aspiration. Medical history was suggestive of foreign body aspiration in 38.4% of the patients, while chest X-ray was indicative in 7% of the patients. TFBs were most often found in the right bronchial tree (75.6%). The most common TFBs were animal and fish bones (39.5%). In 90.7% of the patients they were successfully removed under FBSC, whereas in 8.1% of the patients a TFB was extracted with flexible bronchoscope through endotracheal tube. Surgery was needed in only one case.
Although foreign bodies in the tracheobronchial tree are rare in adults, the clinician must be aware of their likelihood. Foreign body aspiration should be considered especially in the etiology of recurrent lung diseases and in the presence of risk factors for aspiration, in particular with different neurologic and neuromuscular diseases. They can be successfully and safely removed in the majority of patients under local anesthesia by using FBSC. In cases when repeated procedure is needed, endotracheal tube is recommended.
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ABSTRACT: Zusammenfassung Anamnese und klinischer Befund: Wir berichten uber einen 53-jahrigen Patienten mit Verschlechterung der pulmonalen Symptome bei bekannter COPD. Eine allogene hamatopoetische Stammzelltransplantation bei Multiplem Myelom lag 21 Monate zuruck. Untersuchungen: Bei negativer Erregerdiagnostik aus Sputum und Rachenspulwasser lie ss sich in der diagnostischen Bronchoskopie eine halbe Erdnuss als Fremdkorper im rechten Hauptbronchus bergen. Therapie und Verlauf: Nach Bergung des Fremdkorpers besserten sich die Symptome sofort. Folgerung: Verschlechtert sich die pulmonale Symptomatik, sollte auch bei Erwachsenen mit hohem Pneumonierisiko klinisch und diagnostisch eine Fremdkorperaspiration ausgeschlossen werden. Abstract History and admission findings: A 53-year-old male presents with progressive cough and subfebrile temperatures with a history of COPD and post one-year allogeneic hematopoietic stem cell transplantation. Examinations: No pathogenic agent was identified in virological and microbiological diagnostic testings of sputum. At bronchoscopy a half peanut was retrieved from the right main bronchus. Treatment and course: After recovery of the peanut the patient's symptoms immediately improved. Conclusions: Even in adults, with high risk of infectious pneumonia a foreign body aspiration should be considered if pulmonary symptoms worsen.DMW - Deutsche Medizinische Wochenschrift 10/2014; 139(44):2239-41. DOI:10.1055/s-0034-1387312 · 0.55 Impact Factor
Article: Aspiration[Show abstract] [Hide abstract]
ABSTRACT: Aspiration is a condition manifesting with a wide array of clinical presentations from pneumonitis to pneumonia to foreign body inhalation. Isolated or repeated events can result in both short-term and long-term sequelae, particularly in the elderly. There are many modalities utilized for diagnosis ranging from speech evaluation to radiologic imaging to bronchoscopy. However, an accurate history and high clinical suspicion remain essential in identifying those at risk. Management is often dependent on the clinical context. We review the literature with regard to the adult populations at risk, clinical and radiologic findings, and methods of diagnosis and treatment.Clinical Pulmonary Medicine 01/2013; 20(6):271-279. DOI:10.1097/CPM.0000000000000008
01/2015; 17(1). DOI:10.5152/ejp.2015.36844