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Foreign body aspiration: clinical utility of flexible bronchoscopy
O Dikensoy1, C Usalan, A Filiz
1Department of Pulmonary Diseases, Gaziantep University, School of Medicine, Gaziantep, Turkey. dikensoy@yahoo.com
Insights
Foreign body aspiration is a serious global health issue, particularly in children under 3. Early diagnosis and bronchoscopy are crucial for effective treatment and preventing severe complications.
Area of Science:
- Pulmonology
- Pediatric Medicine
- Emergency Medicine
Background:
- Foreign body aspiration is a significant global health concern, frequently leading to life-threatening complications.
- It disproportionately affects children under three years old, with organic materials like nuts and seeds being common culprits.
Observation:
- Clinical presentations vary widely, and a lack of reliable history, especially in children, necessitates a high index of suspicion.
- Standard imaging methods are not diagnostic; bronchoscopy is essential for both diagnosis and treatment.
Findings:
- Flexible bronchoscopy under local anesthesia in adults can facilitate foreign body removal, potentially avoiding more invasive procedures.
- Delayed diagnosis can result in serious complications, including pneumonia, lung abscess, and bronchiectasis, sometimes requiring surgical resection.
Implications:
- Prompt diagnosis and intervention, often via bronchoscopy, are critical for managing foreign body aspiration.
- Even in cases of delayed diagnosis, foreign body retrieval can lead to resolution of some late complications, underscoring the value of preoperative bronchoscopy.
Abstract:
Foreign body aspiration is a worldwide health problem which often results in life threatening complications. More than two thirds of foreign body aspirations occur among children younger than 3 years. Organic materials such as nuts, seeds, and bones are most commonly aspirated. There is a wide range of clinical presentation, and often there is not a reliable witness to supply the clinical history, especially in children. Maintaining a high index of suspicion is therefore necessary for the diagnosis. None of the imaging methods employed in such cases are diagnostic, and bronchoscopy is frequently necessary for the diagnosis as well as the treatment. In adults, removal of the foreign body can be attempted during diagnostic examination with a fibreoptic bronchoscope under local anaesthesia, which may help to avoid any further invasive procedures with more complications. When diagnosis is delayed, complications of a retained foreign body such as unresolving pneumonia, lung abscess, recurrent haemoptysis, and bronchiectasis may necessitate a surgical resection. However, some of the late complications may resolve completely after the retrieval of the foreign body, therefore, a preoperative flexible bronchoscopy should always be considered in suitable cases.