Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital

Foreign Body in the Airway Mimicking Tumour in an Adult: A Case Report

Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.

Foreign-body aspiration into the lower airways in adults; multicenter study

Background

Foreign-body aspiration is common in children aged 6 months to 3 years. However, with the aging population and increasing prevalence of disabilities such as hemiparesis and neuromuscular diseases in adults, an increased incidence of aspiration is expected.

Methods

This was a multicenter retrospective, observational study in four major referral hospitals in Daegu, South Korea, between 2000 and 2019. We included patients aged over 18 years who were evaluated for tracheobronchial foreign-body aspiration by flexible bronchoscopy. Comorbidities, type and location of foreign body, and radiologic findings were recorded.

Results

Of 138 patients who underwent flexible bronchoscopy for tracheobronchial foreign body aspiration, 91 (65.9%) were men; the mean age was 66.3 (range: 29–87) years. A history of definite choking was present in 60 (43.5%) patients. The most common site of the foreign body was the right bronchus intermedius (27.5%). The most common type of aspirated foreign body was teeth (37.7%), followed by chicken bone (15.2%), nuts (14.5%) and fish bone (9.4%). Iatrogenic events accounted for 37.0% of the cases of aspiration, and the foreign body was successfully removed by flexible bronchoscopy in 91.3% of cases.

Conclusion

Foreign-body aspiration is not rare, even in adults who do not have predisposing factors. Iatrogenic events accounted for about 40% of all cases of foreign body aspiration. In adults, flexible bronchoscopy is relatively safe and has a high success rate for foreign-body removal.

A case of an unfortunate tooth fairy visit to a ventilator-dependent child

An 8-year-old boy recently sustained a cerebellar arteriovenous malformation rupture, and subsequently suffered from severe neurological injury and became ventilator-dependent through a tracheostomy. During a routine clinic visit, the parents reported that a loose baby tooth had fallen out and disappeared 7 days earlier. The physical examination was unremarkable, but a chest X-ray demonstrated a foreign body in the left lung and secondary atelectasis. A rigid bronchoscopy extracted what turned out to be a tooth from the left lower lobe bronchus, with no associated sequelae. Aspiration of a tooth is rare, and it is mostly seen in children and elderly patients following trauma, endotracheal intubation, and dental procedures. Only a few previous studies emphasized the increased risk of foreign body aspiration among neurological impaired children. This unique report describes a child in his physiological exfoliation period, which is characterized by the spontaneous shedding of 20 teeth over the course of several years. In severely neurologically impaired children, this period carries a risk of aspiration of teeth and secondary pulmonary damage. Therefore, treating physicians and caregivers must be aware of this risk, and routine dental check-ups are advised in a neurological impaired child during this period.

Application of flexible fiberoptic bronchoscopy in the removal of adult airway foreign bodies

Background

Flexible fiberoptic bronchoscopy is a rapid, cost effective and safe procedure.

Aim

To analyze demographic information and endoscopic findings in adult patients with airway foreign body aspiration and its removal.

Methods

Fifty-seven adults (40 males, 17 females; average age 40 years old) with airway foreign body aspiration were analyzed. Cough (37, 65%) was the most common clinical presentation. The most common foreign body was bone followed by dental prosthesis and food debris.

Results

In the current study, 42 out of the 57 (74%) airway foreign bodies were successfully removed under flexible fiberoptic bronchoscopy. However, it was failed in 15 patients and thus, rigid bronchoscopy was used to remove foreign bodies successfully in 13 of the 15 patients. Thoracotomy was performed for the 2 patients whose foreign body removal was unsuccessful even with rigid bronchoscopy.

Conclusion

The findings of the current study revealed that flexible fiberoptic bronchoscopy is a safe and effective procedure for the removal of adult airway foreign bodies in the majority of cases. Rigid bronchoscopy can be a backup procedure in case flexible bronchoscopy is failed.

Repeated Synchronous Aspiration and Ingestion of a Sharp Metallic Foreign Body in a Mentally Disabled Adolescent

In a mentally disabled adolescent, bronchoscopic extraction failure of a metallic foreign body from the left main bronchus was followed by mediastinal emphysema. At thoracotomy, a part of the metallic hook was found to protrude through the main bronchus, just by the descending aorta. The foreign body was removed and the bronchus sutured. After the thoracotomy closure, laparotomy was performed with removal of metallic pieces from the stomach. After three years, a repeated metallic foreign body aspiration as confirmed by the chest radiography ensued, with metallic pieces in the bowels as well. With the surgical team on site, rigid bronchoscopy was done and the foreign body extracted from the intermediate bronchus. Metallic pieces left the digestive tract spontaneously after a few days. In conclusion, the appropriate preoperative workup and timing for surgery are essential for the treatment outcome of this life-threatening condition; because of the high likelihood of the major airway injury, such procedures should be done with a surgical team available whenever possible.

Management of a case of unacknowledged foreign body in the upper airway

Tracheobronchial foreign body aspiration occurs rarely in adults and may go unrecognized for a long time, but early detection and immediate retrieval of the foreign body are essential to prevent major morbidity. We describe the case of an adult who unusually aspirated part of his dental prosthesis during an attempted strangulation, which was unacknowledged until 6 months later when he was hospitalized with acute respiratory failure and required an emergency surgical tracheotomy. The foreign body was successfully removed via flexible bronchoscopy.

Foreign Body Aspiration: An Unusual Presentation and Outcome

Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement.

Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

Foreign body aspiration (FBA) is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA). The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH). Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.