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Updated: May 31, 2026

Systematic Bronchoscopy: the Four Landmarks Approach
Published on: June 23, 2023
[Management of patients with bronchial foreign bodies]
Masaru Takenaka1, Takeshi Hanagiri, Kenji Ono
1Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Japan, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Insights
Foreign bodies in the airway, often artificial teeth or fish bones, can cause serious respiratory issues in children and the elderly. Early diagnosis and removal are crucial to prevent complications like pneumonia and life-threatening conditions.
Area of Science:
- Respiratory Medicine
- Pediatric Pulmonology
- Geriatric Medicine
Context:
- Bronchial foreign bodies are a significant cause of respiratory distress in both pediatric and geriatric populations.
- Symptoms range from chronic cough and pneumonia to life-threatening dyspnea and cyanosis.
- Delayed diagnosis can lead to irreversible lung damage due to inflammatory granulation.
Purpose:
- To present the clinical characteristics of patients treated for bronchial foreign bodies.
- To highlight the diverse range of symptoms and potential severity.
- To emphasize the importance of early diagnosis and intervention.
Summary:
- This case series details 6 patients (ages 8-83) with bronchial foreign bodies, predominantly artificial teeth, located in the right bronchus.
- Chest X-rays revealed pneumonia or atelectasis in 5 patients.
- Fiberoptic bronchoscopy was the primary treatment, with surgery required in only one instance.
Impact:
- Bronchial foreign bodies necessitate prompt recognition and management to avoid severe respiratory compromise.
- Timely diagnosis is critical, as prolonged impaction complicates removal and increases the risk of permanent lung injury.
- This study underscores the need for heightened clinical suspicion in patients presenting with nonspecific respiratory symptoms, especially when aspiration is suspected.
Abstract:
The aspiration of foreign bodies into the bronchus frequently occurs in children as well as in elderly people. Foreign bodies in the airway not only cause chronic cough and pneumonia, but also result in life-threatening conditions, such as dyspnea and cyanosis. This report presents the clinical characteristics of 6 patients with bronchial foreign bodies who were treated between 2006 and 2010, including 4 male and 2 female patients. The age of the patients ranged from 8 to 83 years old. Foreign bodies were located in the right bronchial tree in all the patients. Chest X-rays showed pneumonia or atelectasis in 5 out of 6 patients. The foreign bodies were an artificial teeth or a tooth in 5 patients, and a fish bone in 1 patient. Five patients had fiberoptic bronchoscopy under local anesthesia, although an 8-year-old girl required general anesthesia with a laryngeal mask. Surgery was needed in only one case. Bronchial foreign bodies present a large range of symptoms, from trivial symptoms to irreversible damage to the bronchus and the lung, which can be life threatening. Nonspecific respiratory symptoms may be mistakenly attributed to other medical diagnoses unless there is a clear history of aspiration. However, an early diagnosis is very important, because inflammatory granulation due to long-term impaction of foreign bodies makes its removal difficult.
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