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[Broncho-pulmonary complications due to aspiration of foreign bodies by children]
A Pogorzelski1, J Zebrak, J Pawlik
1Zespół Pediatryczny Instytutu Gruźicy i Chorób Płuc w Rabce.
Insights
Foreign body aspiration in children often leads to bronchopulmonary disease, especially in those under two. Early removal of foreign bodies (f.b.) prevents irreversible lung damage like bronchiectasis.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Imaging
Context:
- Bronchopulmonary disease in children is frequently caused by foreign body (f.b.) aspiration.
- A significant number of cases (28%) were initially misdiagnosed, lacking suspicion of f.b. aspiration.
- The study reviewed 239 children treated for f.b. aspiration between 1980-1992.
Purpose:
- To analyze the clinical characteristics, diagnostic challenges, and long-term outcomes of foreign body aspiration in pediatric patients.
- To identify common foreign bodies, their locations, and associated radiological findings.
- To evaluate the impact of delayed diagnosis and treatment on the development of chronic irreversible lung lesions.
Summary:
- Foreign body aspiration affected more boys (61.5%) and nearly half (49.7%) were under 2 years old.
- Nuts were the most common aspirated foreign bodies (35.1%), frequently lodging in the right bronchial tree (61.1%).
- Disturbances of bronchial patency were the most common chest X-ray finding (74.1%), while non-metallic objects were harder to detect.
- Chronic irreversible lesions, including bronchiectasis and lung fibrosis, occurred in 18.8% of children, with prevalence directly proportional to the duration of foreign body impaction.
- Timely removal within the first month prevented complications; however, aspiration of grain ears led to bronchiectasis in 80% of cases.
- Left bronchial tree aspiration caused more ventilation disturbances and earlier diagnosis, resulting in 2.7 times less frequent bronchiectasis compared to right-sided impaction.
Impact:
- Highlights the importance of considering foreign body aspiration in pediatric respiratory distress, even without initial suspicion.
- Emphasizes the correlation between delayed foreign body removal and the development of severe, irreversible lung damage.
- Informs clinical practice regarding diagnostic strategies and the critical need for prompt intervention to improve patient outcomes and prevent long-term morbidity.
Abstract:
The paper describes 239 children with bronchopulmonary disease due to foreign body (f.b.) aspiration treated in our center during between 1980-1992. Twenty-eight percent of the cases had been referred to hospital without any suspicion of f.b. aspiration. Almost half of the children (49.7%) were below the age of 2 years. Boys were affected more often (61.5%) than girls. In 61.1% the cases the f.b. had been aspirated into the right bronchial tree. Pieces of nuts were the most common f.b. - 35.1%. The most common chest X-ray symptoms were disturbances of bronchial patency (74.1%). Non-metalic, but potential shadowing f.b. like bones and teeth gave the clear signs only in 17.6% of the cases. After f.b. aspiration chronic irreversible lesions such as bronchiectasis and lung fibrosis were observed in 18.8% of the children. The prevalence of bronchiectasis was proportional to the duration of deposition. If the f.b. had been removed within the first month after aspiration we observed no complications. After aspiration of ears of grain, bronchiectasis was present in 80% of cases. Aspiration of f.b. into the left bronchial tree very often caused ventilation disturbations. Such cases were diagnosed and treated earlier than cases of right side f.b. aspirations. As a consequence bronchiectasis in the left lung was observed 2.7 less frequently.