Rigid bronchoscope in cases suspected of foreign body inhalation

Abstract EN

Objectives : The aim of this study is to assess the percentage and management of cases suspected of foreign body aspiration and to investigate the role of physical and radiological findings before bronchoscope in the diagnosis of foreign body aspiration (FBA).

Methods: This study was performed in 31 children (age range from 5 months to 11 years with mean age 28.2 months) with a history suggestive of FBA.

Chest x-ray was done for all patients, while computerized tomographic (CT) scan was done for 5 patients.

Rigid bronchoscope was done for all patients.

Results : The presence of foreign body (FB) in the tracheobronchial airway was confirmed in 21 patients (12 boys and 9 girls).

The presenting symptoms were: cough (76.2%), dyspnea (71.4%), wheezing (66.7%) and hemoptysis associated with weight loss and anorexia (4.8%).

Examination revealed rhonchi (90.5%), repetitions (38.1%), diminished breath sound (85.7%) and low O2 saturation (below 90%) (52.4%).

Chest X-ray was normal in 5 patients (23.8%).

Of the 16 patients with positive X-ray findings, radio-opaque FB (metallic) could be detected in 2 patients (12.5%), hyperinflation on the side of entrapment of FB (56.5%), atelectasis (18.75%), lobar collapse (12.5%), and pneumothorax (12.5%).

In 14 patients (66.7%) there was delay in diagnosis from 5 days to 3 months (mean 14.4 days).

The FBs were located in the trachea (9.5%), in the right main bronchus (57.1%) and in the left main bronchus (33.3%).

There was granulation in 1 patient who presented with hemoptysis.

Five of the removed FBs (23.8%) were non-organic in nature (3 plastic and 2 metallic) and 16 (76.2%) were organic in nature.

In 10 patients without FBs the presenting symptoms were cough (70%), wheezing (80%) and dyspnea (60%).

Physical findings were rhonchi (70%), crepetations (80%), diminished breath sound (50%), and low O2 saturation (80%).

Chest X-ray was normal in 4 patients (40%).

Of the 6 patients with positive X-ray findings, the findings were collapse (40%), and hyperinflation (20%) All the tested parameters showed poor sensitivity, specificity, and predictive values.

Conclusion : Tracheobronchial FB inhalation continues not to alarm the general and medical population as 66.7% presented late.

Radiographic findings often suggest but do not diagnose FBA.

To prevent delayed diagnosis, characteristic symptoms, and clinical and radiologic signs of FBI should be checked in all suspected cases.

The use of ventilating rigid bronchoscope is the instrument of choice for removing tracheobronchial FBs.