Tracheo-bronchial foreign bodies

Suspicion of foreign bodies inhalation is a frequent problem in clinical practice. Despite the fact that the parents or the patients themselves easily notice symptoms, the delay in initiating diagnostic procedures is important. Delaying diagnosis and extraction results in potential severe complications. Diagnosis and treatment rely on invasive bronchoscopic procedures and therefore a careful designed standardized evaluation should be employed in order to decrease unnecessary bronchoscopies. Classical clinical signs of foreign body inhalation have low positive predictive values and every attempt to confirm or exclude the diagnosis should be done. Patients should be addressed to experienced centers for evaluation and treatment. Confirmation of the diagnosis should be done by flexible bronchoscopy. Extraction generally relies on rigid bronchoscopy, which seems to be more secured. Flexible bronchoscopy can also be used for extraction but rigid bronchoscopy should be always immediately available. Extraction failure rate and complications are rare in hands of experienced individuals and surgical removal is seldom necessary.