A study of clinical presentations and complications of foreign body in the bronchus - own experience
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Omkar Halwai1, Ameya Bihani1, Arpit Sharma
1Department of Otorhinolaryngology and Head Neck Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India.
Insights
Foreign body aspiration in children often presents with cough and decreased air entry. Rigid bronchoscopy is a safe and effective diagnostic and therapeutic procedure with minimal complications.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Imaging
Background:
- Airway foreign bodies are a significant cause of respiratory distress in children.
- Early diagnosis and intervention are crucial to prevent severe complications.
Purpose of the Study:
- To investigate the clinical presentations and complications of airway foreign bodies in pediatric patients.
- To evaluate the safety and efficacy of rigid bronchoscopy for foreign body removal.
- To assess the role of imaging modalities like CT virtual bronchoscopy.
Main Methods:
- A prospective observational study included 46 pediatric patients (<12 years) with suspected foreign body aspiration.
- All patients underwent rigid bronchoscopy under general anesthesia.
- Diagnostic tools included history, clinical examination, chest X-ray, and CT virtual bronchoscopy when indicated.
Main Results:
- The most common age group was 1-3 years, with cough and unilateral decreased air entry as primary symptoms/signs.
- Organic foreign bodies, particularly peanuts, were most common, often lodged in the right bronchus.
- Chest X-ray commonly showed emphysema (71.7%); CT virtual bronchoscopy had 80% sensitivity.
- Rigid bronchoscopy resulted in rare, conservatively managed complications and zero mortality.
Conclusions:
- A definitive history of aspiration is sufficient indication for bronchoscopy.
- Clinical signs and imaging guide localization and management of airway foreign bodies.
- CT virtual bronchoscopy aids diagnosis in ambiguous cases.
- Expert coordination during bronchoscopy minimizes complications.
Objectives:
In this study, we studied varied clinical presentations and complications of a foreign body in the airway and complications of bronchoscopy, if carried out.
Methods:
A prospective observational clinical study in a tertiary care centre from June 2010 to May 2012 included 46 paediatric patients aged less than 12 years, with suspected foreign body aspiration, all of whom underwent rigid bronchoscopy under general anaesthesia. All the patients were subjected to history taking, clinical examination, and investigations (pre- and post-op chest X-ray and CT virtual bronchoscopy, if required).
Results:
The most common age of presentation was 1 to 3 years, within 48 hours from aspiration. A total of 87% of patients had a definite history of aspiration, with cough (69.5%), and unilateral decreased air entry (91.3%) being the most common symptom and clinical sign, respectively. Emphysema was the most frequent finding on chest X-ray (71.7%), and the sensitivity of CT virtual bronchoscopy was 80%. Majority of the foreign bodies were organic (84.7% - especially peanuts) and mostly found in the right bronchus (47.8%). Post-op complications were rare (pneumothorax, pneumonic patch), and were managed conservatively. None of the patients required a tracheostomy and there was zero mortality.
Conclusions:
A positive history is by itself an indication for bronchoscopy. Clinical signs and X-ray changes should guide the clinicians towards the possible location of the foreign body. CT virtual bronchoscopy can be carried out in suspected cases with no specific history or clinical signs. Bronchoscopy can be conducted with minimal complications when performed by co-ordination of an expert surgeon and an anaesthetist.
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