Inhaled Foreign Bodies: Presentation, Management and Value of History and Plain Chest Radiography in Delayed Presentation

Abstract

OBJECTIVES: To assess the clinical and management aspects of tracheobronchial foreign body (FB) in children and adults; to judge the influence of the operator's experience on the outcome of the procedure and to evaluate the factors associated with delayed diagnosis of FB aspiration (FBA) in children; and to compare clinical, radiologic and bronchoscopic findings in the patients with suspected FB inhalation (FBI). STUDY DESIGN AND SETTING: Retrospective review of a 10-year experience (from 1995 to 2005), involving a 1512-bed Mansoura university hospital and a 184-bed Mansoura emergency hospital. MATERIAL AND METHODS: Three thousand three hundred patients underwent rigid bronchoscopy for suspected FBI between 1995 and 2005 in Mansoura, Egypt. The data were analyzed in 3 groups: the patients with negative bronchoscopy for FBI (group 1), early (group 2), and delayed diagnosis (group 3). Foreign body was removed using the rigid bronchoscope with or without using the extracting forceps (Egyptian novel technique; Sersar technique). RESULTS: The penetration syndrome and decreased breath sounds were determined in a significantly higher number of the patients with FBI. The plain chest radiography revealed radiopaque foreign bodies (FBs) in 23.56% of all patients with FBI. Pneumonia and atelectasis were more common in the groups with negative bronchoscopy and with delayed diagnosis ( P < 0.01). The FBs were mostly of vegetable origin, such as seeds and peanuts. The Egyptian novel (Sersar) technique was used since 2004 April in 100 cases (4.62%) with a history of FBI (pins and or small rounded materials). It was successful in 73 cases of nonimpacted inhaled pins. CONCLUSIONS: Bronchoscopy is indicated on appropriate history and on suspicion. To prevent delayed diagnosis, characteristic symptoms, and clinical and radiologic signs of FBI should be checked in all suspected cases. Because clinical and radiologic findings of FBI in delayed cases may mimic other disorders, the clinician must be aware of the likelihood of FBI. EBM rating: C-4