A Retrospective Review of Tracheobronchial Foreign Bodies

Son, Chang Young; Wee, Jeong Ook; Kim, Soo Ock; Oh, In Jae; Park, Chang Min; Kim, Kyu Sik; Kim, Yu Il; Lim, Sung Chul; Lim, Sang Chul; Kim, Young Chul; Park, Kyung Ok

Abstract

BACKGROUND: The development of bronchoscopic equipment along with the precision of radiographic techniques had reduced the mortality rate of patients with tracheobronchial foreign bodies but has been no change in the incidence of tracheobronchial foreign bodies since their introduction. The aim of this study was to assess the clinical characteristics of a tracheobronchial foreign body aspiration and to evaluate the efficacy of the treatment modality in children and adults.
METHODS
This is a retrospective review of 64 patients who underwent bronchoscopic procedures for the treatment of aspirated foreign bodies from December 1994 through March 2004 at the Chonnam national university hospital.
RESULTS
There were 47 males and 17 females, aged from 1 month to 78 years. Most of the patients had no underlying illness except for one patient with a cerebrovascular accident that contributed to the foreign body aspiration. The most common symptom was cough, which was noted in 54 patients (84.3%). The other presenting symptoms were dyspnea (48.8%), fever (20.3%), sputum (14%), vomiting (7.8%), and chest pain (4.6%). Those whose tracheobronchial foreign bodies were diagnosed more than 2 days after the aspiration (21 patients) were more likely to have pneumonia than those whose foreign bodies were diagnosed within 2 days (p=0.009). Foreign bodies were visualized in the plain chest radiographs in 12 cases (18.8%), while others showed air trapping (21, 32.8%), pneumonia (15, 23.4%), atelectasis (7, 10.9%), and normal findings (9, 14.1%). The foreign bodies were more frequently found in the right bronchial tree (36) compared with the left bronchial tree (22, p=0.04). In order to remove the foreign bodies, twenty (31.2%) cases were removed using flexible bronchoscopy, while 42 (65.6%) and 2 (3.2%) cases required rigid bronchoscopy and surgery, respectively.
CONCLUSIONS
Tracheobronchial Foreign body aspiration had a bimodal age distribution in the infancy and old age around 60 years. They were found more frequently in the right bronchial tree. In addition, patients whose foreign bodies were diagnosed more than 2 days after the aspiration were more likely have a infection. Rigid bronchoscopy is the procedure of choice for uncooperative children and for those with foreign bodies lodged deeply in the small bronchial tree.