A Case of Foreign Body Aspiration Mimicking Asthma in Adult

@#Foreign body aspiration is uncommon in adults who have no known risk factors such as mental retardation, poor dentition, or advanced age. Adults with foreign body aspiration are commonly misdiagnosed with bronchial asthma, however, does not respond to standard bronchodilator treatment. A thorough history-taking, focused physical examination and a high index of suspicion is crucial in making the correct diagnosis. This paper reports an interesting case of a 41- year-old woman with an undetected 10-year long foreign body aspiration which was misdiagnosed as bronchial asthma.

Wandering airway foreign body in early infancy

Accidental impaction of objects in the respiratory passage is a life-threatening condition. A 9-month-old male infant was admitted with fever, cough and respiratory distress without history of choking. He was treated as wheezy bronchitis with appropriate therapy but, did not show response. HRCT showed an impacted foreign body in the trachea which caused a partial luminal compromise. Two attempts to remove foreign body by rigid bronchoscope failed, and tracheostomy was performed due to fall in oxygen saturation. After stabilization, again saturation was falling and air entry was absent on right hemithorax. Considering the possibility of movement of foreign body in right bronchus, bronchoscope was reintroduced and foreign body was removed in piecemeal. This process was complicated with cardiorespiratory arrest, twice from which the patient was revived. Postoperative period was uneventful. So, high index of suspicion is required to diagnose such a foreign body of the tracheobronchial tree to prevent morbidity and mortality.

Foreign Body Aspiration in Left Bronchus in a Pediatric Patient - A Case Report

Introduction: Pediatric population is more prone for foreignbody aspiration. It is a preventablecause of mortality andmorbidity in children. Stone aspiration is one of the rarecauses foreign body aspiration in bothchildren and adults.Case Report: We present a 1-year old child who had historyand examination suggestive of pneumonia which turned outto be a foreign body in left bronchus on chest x-ray PA. Theforeign body was removed by flexible bronchoscopy withoutany complication.Conclusion: The child’s symptoms improved satisfactorilyfollowing removal. History is vital and can guide treatment incase of foreign body aspiration.

Metallic hair pin aspiration into the left tertiary bronchus

Foreign body aspiration is commonly described in infants and children. However, recently, a newhigh-risk group was identified among young women, especially those from the Muslim populationwho wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between thelips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing thescarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present acase of scarf pin inhalation and the challenges encountered in managing this patient during thesuccessful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particularcase was technically challenging for us as the sharp tip of the needle was pointing upward andpiercing the bronchial mucosa.

Prevention and management of foreign body ingestion and aspiration during the dental treatment

Prosthetic restorations through implants were popularized, and they became routine treatments. Small accessories used in the implant prosthodontic procedure are more likely to slip or fall off the dentist's hands. If the dental appliance or material passes into the upper gastrointestinal tract, there is a high possibility of excretion to the outside of the body without complications, but serious complications may occur depending on the type of foreign body. If the foreign body is passed to the airway, it is an emergency situation, and if it is not done properly, it can be fatal. The purpose of this review report is to investigate the process of foreign body ingestion or aspiration during dental treatment, and the method of prevention and treatment.

Peligro de asfixia: conocimiento de los padres sobre la aspiración de cuerpos extraños en niños / Choking hazard: parental knowledge on foreign body aspiration in children / Perigo de asfixia: o conhecimento dos pais sobre aspiração de corpos estranhos em crianças

La aspiración de un cuerpo extraño es una causa importante y prevenible de morbimortalidad en la infancia. Uno de los factores de riesgo principales de la asfixia es la falta de conocimiento de los padres y cuidadores acerca de los objetos peligrosos, las situaciones de riesgo y los signos clínicos de un cuerpo extraño en la vía aérea. Para evitar eventos de asfixia y realizar diagnósticos oportunos para el manejo adecuado, el conocimiento en la comunidad acerca de esta problemática debe aumentar. Evaluamos el conocimiento de los padres sobre la aspiración de cuerpos extraños en niños a fin de proponer estrategias de prevención y evitar nuevos accidentes.

The aspiration of a foreign body is an important and preventable cause of morbidity and mortality in childhood. One of the major risk factors of asphyxia is that parents or caregivers may lack knowledge of the dangerous nature of many objects, risk situations, and clinical signs of a foreign body in the airway. To avoid choking events and make an early and adequate diagnosis for the proper management of this unfortunate event, community awareness should be increased. We evaluate how much parents know about the aspiration of foreign bodies in children in order to propose prevention strategies as well as to avoid further accidents.

A aspiração de corpo estranho é uma causa importante e evitável de morbidade e mortalidade na infância. Um dos principais fatores de risco de asfixia é a falta de conhecimento dos pais e cuidadores sobre objetos perigosos, situações de risco e sinais clínicos de um corpo estranho na via aérea. Para evitar a asfixia eventos e fazer diagnósticos atempados para a correcta gestão, o conhecimento da comunidade sobre este problema deve aumentar. Nós avaliar o conhecimento dos pais sobre aspiração de corpo estranho em crianças, a fim de propor estratégias para a prevenção e evitar novos acidentes.

Identification and management of wheezing caused by foreign body aspiration in children / 中国小儿急救医学

Foreign body aspiration is a common critical emergency in children,and 1 to 3 years old children are common, and it can lead to a series of complications, and even life-threatening. The clinical symptoms of foreign body aspiration are often manifested as cough and asthma,and early wheezing symptoms are easily confused with symptoms of bronchitis, misdiagnosis and missed diagnosis can cause difficulty in treatment and even lead to serious complications. The differential diagnosis between foreign body aspiration and bronchitis depends on history,clinical manifestation and imaging,and bronchoscopy is an effective and direct method of diagnosis. The diagnosis and treatment of foreign body aspiration in children need compre-hensive evaluation of airway inflammatory status and perioperative comprehensive treatment,so as to effec-tively avoid complications and reduce mortality.

The effect of Foreign Body Aspiration training on the knowledge level of pupils / Efeito do treinamento em aspiração de corpo estranho no nível de conhecimento de estudantes

ABSTRACT INTRODUCTION: Educators dealing with 0-6 years old children must be individuals who are willing to take all kind of measures in order to ensure the safety of children in educational institutions and playgrounds, providing protection from diseases, and who are able to apply first aid measures in case of an accident. OBJECTIVE: In this study, we aimed to determine the level of knowledge of all students continuing their education in the department for child development, regarding Foreign Body Aspiration (FBA) and the effect of FBA training on their knowledge level. METHODS: This semi-experimental study was carried out on high-school students (n = 123) continuing their education in the department for child development in Corum, Turkey. The data was evaluated with appropriate statistical methods, and p < 0.05 was determined as statistically significant. RESULTS: Before the training, 80% of the high-school children knew the importance of age factor in cases of FBA, improving to 92% after training. The increase in the number of students who were aware of the importance of age factor was statistically significant (p < 0.05). CONCLUSION: As a result of the training, the visual presentation and training on models related to FBA have led to an increase in the knowledge level of the students.

Resumo Introdução: Os educadores que lidam com crianças de 0-6 anos devem ser pessoas dispostas a usar todos os tipos de medidas que assegurem a segurança das crianças em instituições educacionais e em playgrounds, proporcionando proteção contra doenças e aplicando medidas deprimeiros socorros em caso de acidentes. Objetivo: Neste estudo, objetivamos determinar o nível de conhecimento de estudantes em um departamento de desenvolvimento infantil, com relação à aspiração de corpo estranho (ACE), e o efeito do treinamento para ACE em seu nível de conhecimento. Métodos: Realizamos estudo do tipo semiexperimental em todos os estudantes (n = 123) que estavam dando continuidade à sua educação no departamento de desenvolvimento infantil de uma instituição de educação secundária em Corum, Turquia. Os dados foram avaliados com métodos estatísticos apropriados. Adotamos p < 0,05 como nível estatisticamente significante. Resultados: Antes do treinamento, 80% dos escolares tinham conhecimento da importância do fator idade nos casos de ACE; depois do treinamento, esse percentual se elevou para 92%. Houve aumento estatisticamente significante no número de estudantes que percebiam a importânciado fator idade (p < 0,05). Conclusão: Como resultado do treinamento, a apresentação visual e o treinamento em modelos com relação à ACE levaram a um aumento no nível de conhecimento dos estudantes.

A 15-year occult foreign body in the subglottic area of a 50-year-old woman

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of subglottic foreign body (FB) impaction in a 50-year-old woman diagnosed with bronchial asthma for 15 years.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Public Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 50-year-old woman with recurrent cough and dyspnea for 15 years that had been managed as a bronchial asthma developed stridor and halitosis in the last 5 years. Flexible laryngoscopy revealed a subglottic mass and CT scan confirmed a suspicious foreign body in the lumen of the subglottis. Signs and symptoms resolved after peroral endoscopic removal of the foreign body from the larynx. Histopathology of the extracted material from the airway confirmed it to be "bone tissue".<br /><strong>CONCLUSION:</strong> Foreign body aspiration can occur in adults without predisposing factors. Its diagnosis can be challenging as it can mimic respiratory disorders such as bronchial asthma. Endoscopy and computed tomography are valuable for correct diagnosis and management. An incorrect initial diagnosis should be considered in the light of unresolved symptoms and prompt referral to an appropriate specialist may prevent undue suffering and dangerous complications. </p>

Foreign body aspiration in 48 children: clinical manifestations and outcomes

PURPOSE: This study aimed to have a deeper insight into the clinical spectrum of foreign body aspiration in children and to prospect the further clinical implications of early diagnosis. METHODS: We conducted a retrospective medical chart review of 48 children with foreign bodies at The Catholic University of Korea, Seoul St. Mary's Hospital, between January 2009 and December 2013 in terms of age, sex, symptoms and signs, radiologic findings, and clinical courses. Patients were divided into 2 groups according to the time from aspiration to a definite diagnosis. The 2 groups were compared for clinical courses, radiologic findings, and the length of hospitalization. RESULTS: Approximately 85% of patients were 3 years of age or younger. About one-fifth of patients had no history of foreign body aspiration. Cough and coarse breathing sounds were the most common symptoms and signs. The most frequent radiologic finding was pulmonary air trapping (33.3%). The mostly commonly aspirated foreign body was peanut and detected in left main bronchus. Cough, sputum, and absence of aspiration history were more common in the delayed diagnosed group than in the early diagnosed group. CONCLUSION: Our results suggest that the number of accidents associated with foreign body aspiration can be reduced by keeping infants with nut formula under close observation and by conducting assertive bronchoscopic examination on children with delayed recovery from respiratory infections. After removal of foreign bodies, close monitoring and expectation of possible complications can prevent patients from a long hospital stay.

Radiodensity on Serial Chest X-rays for the Diagnosis of Foreign Body Aspiration in Children.

Objectives: To evaluate the utility of measuring lung radiodensity from chest X-ray for the diagnosis of foreign body aspiration Methods: Records of 59 children with foreign body aspiration were retrospectively reviewed. Lung radiodensity and radiodensity ratio (right/left lung radio density) before and after foreign body removal were measured. Radiodensity was calculated as the relative score compared with the tenth thoracic vertebra body (100 points) and the background (0 point). The change of radiodensity ratio (difference in radiodensity ratio of the second X-ray from that of first X-ray) was compared between 22 patients (foreign body group) and 22 normal subjects (control group). Results: In the group of foreign body in the left bronchus, the mean (SD) radiodensity of the left lung [53.5 (12.8)] was lower than that of the right lung [60.8 (7.7), P<0.01] and it increased after foreign body removal [60.0 (6.9), P=0.02]. The radiodensity ratio decreased from 1.20 (0.30) to 0.96 (0.09) (P<0.01) after foreign body removal. In the group with a foreign body in the right bronchus, the radiodensity of the right lung [51.8 (12.8)] was lower than that of left lung [62.0 (11.7), P=0.03], and it also increased after foreign body removal [58.4 (9.6), P=0.03]. The change of radiodensity ratio in the foreign body group [15.7 (17.8)%] was higher than the control group [5.4 (4.3)%, P=0.01] and the cutoff value was 7.5%. Conclusion: Radiodensity from chest X-ray could be a useful tool for diagnosing foreign body aspiration in children.

Unusual Foreign Bodies in the Respiratory Tract of Children.

Background: Diagnosis of a foreign body without history of aspiration has always been a challenge to pediatricians.Case Characteristics: Four cases presented with non-relieving acute or chronic history of respiratory symptoms. Observations: All of them had unusual types of foreign bodies – plastic flower toy, button, sticker or stone in their respiratory tract. Outcome: All four patients improved after removal of the foreign body. Message: A differential diagnosis of foreign body should always be made in an acute or chronic presentation of respiratory cases.

Aspiración de cuerpo extraño durante la consulta dental en pediatría: Reporte de un caso / Foreign body aspiration in dental office: Founded suspicion for late diagnosis. Case presentation and literature review

Dentro de la práctica clínica en pediatría existen situaciones en las que el diagnóstico oportuno de una enfermedad involucra la meditación de situaciones insospechadas; en niños muy pequeños el interrogatorio indirecto bien realizado y detallado se convierte en herramienta fundamental para su tratamiento. En un evento de aspiración de cuerpo extraño existen indicadores específicos para tener sospecha de que estamos ante un caso; sin embargo, no todos los pacientes presentan signos y síntomas clásicos, por lo que la experiencia del clínico es vital. Se presenta el caso de un niño de veintiún meses de edad que broncoaspiró una corona de acero cromo en un consultorio dental; ésta no fue identificada sino hasta 60 días después del accidente. Es importante que los clínicos encargados de la salud bucal de los niños estén capacitados para auxiliar a sus pacientes ante un evento de aspiración de cuerpo extraño, tanto de forma inmediata como mediata, teniendo una conducta responsable ante la sospecha fundamentada de que ocurrió un accidente de esta naturaleza.

Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. The present study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax X-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient's safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient's life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.

Study of foreign body aspirations.

Objective: Foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure Methods: In our Hospital, bronchoscopy was performed on 105 patients with the diagnosis of foreign body aspirations.Of these cases, 65.77% were male and 34.29% female. Their ages ranged from 2 months to 13 years. Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. Results: Foreign bodies were localized in the right main bronchus in 59 (56.19%) patients followed by left main bronchus in 191 (18.8%), trachea in 173 (17.1%), vocal cord in 75(7.4%) and both bronchus in 28 (26.67%). Foreign body was not found during bronchoscopy in 4 cases (3.81 %). The majority of the foreign bodies were ground nut. Foreign bodies were removed with bronchoscopy in all cases Conclusion: Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.

Diagnóstico tardío de la aspiración de un cuerpo extraño / Delayed diagnosis of foreign body aspiration

Introducción. La aspiración de cuerpos extraños es un problema común en el paciente pediátrico y representa una causa importante de morbilidad y mortalidad. En Estados Unidos se considera la causa de 7% de las muertes accidentales de niños de entre 1 y 3 años de edad. La presentación clínica requiere de un alto grado de sospecha diagnóstica por el médico, sobre todo cuando el antecedente del evento de atragantamiento no es claro en la historia clínica debido a que la exploración física y los hallazgos radiológicos son inespecíficos en la mayoría de las ocasiones. Caso clínico. Se presenta el caso de un adolescente de 14 años que, a pesar de tener el antecedente de la aspiración de un cuerpo extraño, no se le dio importancia y sus síntomas se confundieron con otras entidades. Recibió diversos tratamientos pero sus síntomas se mantuvieron por un año. Fue remitido a la Unidad de Neumología Pediátrica Fernando Katz del Instituto Nacional de Enfermedades Respiratorias donde se realizó el estudio broncoscópico y la extracción del cuerpo extraño del bronquio intermedio. Conclusiones. El diagnóstico tardío ocasiona problemas respiratorios que van desde la obstrucción de las vías aéreas (que pone en riesgo la vida) hasta síntomas respiratorios crónicos como sibilancias e infecciones recurrentes de las vías respiratorias. Es común también que estos síntomas se confundan con otras entidades patológicas como el asma, el reflujo gastroesofágico y la disfunción laríngea.

Background. Aspiration of foreign bodies in the central airway is a common problem in the pediatric population, representing a major cause of morbidity and mortality in our country. In the U.S., foreign body aspiration is the cause for 7% of accidental deaths in children between 1 and 3 years of age. Clinical diagnosis requires a high degree of suspicion in the medical history especially when the choking event is unclear in the clinical history because physical examination and radiological findings have a low sensitivity. Case report. We present the case of a 14-year-old male with a history of foreign body aspiration. The patient's symptoms were given little importance. A 1-year delay in diagnosis occurred due to symptoms mimicking other pathologies. The patient was referred to the Pediatric Pulmonology Unit "Fernando Katz" of the National Institute of Respiratory Diseases where bronchoscopic exploration was performed with removal of foreign body (plastic object) from the intermediary bronchus. Conclusions. Delayed diagnosis causes respiratory problems ranging from life-threatining airway obstruction to chronic respiratory symptoms such as wheezing and recurrent respiratory infections. It has been shown that these symptoms can be confused with other pathologies such as asthma.

Case Series of Foreign Body Aspiration in Paediatric Institute, Hospital Kuala Lumpur

A retrospective case series was conducted to determine the clinical characteristics and bronchoscopy findings of children with foreign body aspiration in Paediatric Institute, Hospital Kuala Lumpur. Ten boys and two girls were included (range 2-177 months; median 26 months old). They commonly presented with cough (12 / 100%) and difficulty in breathing (9 / 75%). All patients had unilateral auscultatory findings and the commonest radiographic findings were unilateral hyperinflation (7 / 58.3%). The majority of foreign bodies removed was organic (8 / 66.6%) and more frequently found in the left bronchial tree (7 / 58.3%). Major complications were pneumonia (11 / 91.6%) and airway oedema (11 / 91.6%). Eight patients had delayed diagnosis due to parents unawareness (6 / 50%) and missed diagnosis (2 / 16.7%)

Clinical value of chest CT in the diagnosis and management of tracheobronchial foreign bodies / 中国小儿急救医学

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.

Bronchial foreign body aspiration diagnosed with MDCT / 소아과

Foreign body aspiration (FBA) is a common accident in young children. Undiagnosed and retained foreign bodies may result in severe early and late complications such as asphyxia, pneumonia, atelectasis and bronchiectasis. Moreover, because it can mimic bronchiolitis, croup or asthma, an accurate history and a high index of suspicion are of paramount importance for early diagnosis. With our experience on bronchial FBA initially misdiagnosed as acute bronchiolitis, we emphasize that a minute radiological finding should not be neglected and a repeat chest radiograph may be helpful when the initial study shows normal findings. Multidetector computed tomography is a very useful noninvasive diagnostic modality for FBA.

Diagnosis and Clinical Courses of 108 Foreign Body Aspiration Cases / 소아알레르기및호흡기학회지

PURPOSE: Foreign body aspiration in the tracheobronchial tree is a common medical emergency in children and represents an important cause of morbidity and mortality. This study was aimed to analyze the clinical spectrum of tracheobronchial foreign bodies in children and to evaluate the causes of late diagnoses. METHODS: A total of 108 patients with foreign body aspiration were recruited in the last 10 years, who had a flexible or rigid bronchoscopic examination. The age, sex, symptoms, causes of aspiration, radiologic findings, and clinical courses were investigated retrospectively. Patients were divided into 2 groups according to the elapsed time from aspiration to a definite diagnosis as early (24 hours after aspiration). The two groups were compared for clinical courses, radiologic findings, and the duration of admission of early- and late-diagnosed foreign body aspiration. RESULTS: Approximately 80% of the patients were less than 24 months of age and the most common symptoms were the sudden onset of a cough. Hyperinflation or obstructive emphysema (52.8%) and normal chest radiographs (19.4%) were the most frequent radiologic findings. Plain chest radiographies revealed visible foreign bodies in 7.4% of all patients with foreign body aspiration. Nuts were the most common foreign bodies aspirated. Sudden onset of a persistent cough and fever were predominant in the late-diagnosed group.(P<0.05) CONCLUSION: Our results suggest that clinical suspicion upon interviewing is enough to indicate bronchoscopy. The best way to reduce the number of accidents and deaths associated with foreign body aspiration is to promote public prevention polices.

Values of Lung CT in Children with a Vague History of Aspiration / 소아과

PURPOSE: The purpose of this study was to investigate the diagnostic value of spiral computed tomography (CT) using contiguous slices with partially thin sections around the hilar level in the bronchial foreign bodies of children with a vague history of aspiration. METHODS: Fourteen children were identified to be examined with spiral CT due to obscure histories of aspiration episodes. A retrospective analysis of the medical records provided information concerning the clinical and radiological findings. RESULTS: Of the 14 patients examined with spiral CT, there were no significant differences among the clinical and initial radiological findings with the exception of gender distribution. However, the spiral CT scans allowed accurate discrimination among patients with a vague history of aspiration episodes, in which seven were identified with bronchial foreign body aspiration and seven with bronchiolitis, asthma, tracheobronchitis and/or pneumonia. CONCLUSION: We found that spiral CT using contiguous slices with partially thin sections around the hilar level are a useful non-invasive method in the early diagnosis of bronchial foreign bodies in children with a vague history of aspiration.