Tuberc Respir Dis.  2008 May;64(5):356-361. 10.4046/trd.2008.64.5.356.

Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration

• Kim YH
• Choi CW
• Choi HS
• Park MJ
• Kang HM
• Yoo JH

• KMID: 1478191
• DOI: http://doi.org/10.4046/trd.2008.64.5.356

Abstract

BACKGROUND
We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope.
METHODS
From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope.
RESULTS
14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications.
CONCLUSION
This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

Keyword

Foreign body; Aspiration; Flexible bronchoscope

MeSH Terms

Adult
Alligators and Crocodiles
Biopsy
Bronchoscopes
Chest Pain
Cough
Dyspnea
Eating
Fever
Foreign Bodies
Hemoptysis
Humans
Jaw
Medical Records
Pneumonia
Pulmonary Atelectasis
Respiratory Sounds
Retrospective Studies
Surgical Instruments
Thorax
Tooth

Reference

1. Rafanan AL, Mehta AC. Adult airway foreign body removal. What's new? Clin Chest Med. 2001. 22:319–330.

2. Ramirez-Figueroa JL, Gochicoa-Rangel LG, Ramirez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol. 2005. 40:392–397.

3. Lamaze R, Trechot P, Martinet Y. Bronchial necrosis and granuloma induced by the aspiration of a tablet of ferrous sulphate. Eur Respir J. 1994. 7:1710–1711.

4. Debeljak A, Sorli J, Music E, Kecelj P. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998. Eur Respir J. 1999. 14:792–795.

5. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990. 112:604–609.

6. Killian G. Meeting of the Society of Physicians of Freiburg. Dec 17, 1897. Muchen Med Wschr. 1898. 45:378.

7. Yoo JH, Yoon KH, Kang HM. Fiberoptic bronchoscopy for removal of endobronchial foreign bodies in adults. Tuberc Respir Dis. 1991. 38:116–118.

8. Bolliger CT. Interventional bronchoscopy. Schweiz Rundsch Med Prax. 1994. 83:1378–1382. German.

9. Fulginiti J 3rd, Dedhia HV, Kizer J, Timberlake G. Retrieval of an aspirated bullet fragment by flexible bronchoscopy in a mechanically ventilated patient. Chest. 1993. 103:626–627.

10. Pirozynski M, Zaleska J, Polubiec-Kownacka M. Use of fiberoptic bronchoscopy for removal of foreign bodies from the lower respiratory tract. Pneumonol Alergol Pol. 1994. 62:254–259. Polish.

11. Kim IG, Brummitt WM, Humphry A, Siomra SW, Wallace WB. Foreign body in the airway: a review of 202 cases. Laryngoscope. 1973. 83:347–354.

12. Martinot A, Closset M, Marquette CH, Hue V, Deschildre A, Ramon P, et al. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration. Am J Respir Crit Care Med. 1997. 155:1676–1679.

13. Chang JH, Kim SK, Chung KY, Min DW, Shin DH, Lee HL, et al. A case of bronchial obstruction due to occult aspiration of a tooth. Tuberc Respir Dis. 1993. 40:442–448.

14. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J. 1994. 7:510–514.

15. Mayr J, Dittrich S, Triebl K. A new method for removal of metallic-ferromagnetic foreign bodies from the tracheobronchial tree. Pediatr Surg Int. 1997. 12:461–462.

16. Saito H, Saka H, Sakai S, Shimokata K. Removal of broken fragment of biopsy forceps with magnetic extractor. Chest. 1989. 95:700–701.

17. Kwon KS, Park MY, Kim KC, Yeom KH, Lee CS, Jung KY, et al. A case of pneumonia due to occult aspiration of a twig. Tuberc Respir Dis. 1996. 43:108–112.