Treatment of 38 cases of foreign body aspiration in children causing life-threatening complications

doi:10.1016/j.ijporl.2009.08.003

International Journal of Pediatric Otorhinolaryngology

Volume 73, Issue 12, December 2009, Pages 1624-1629

https://doi.org/10.1016/j.ijporl.2009.08.003 Get rights and content

Abstract

Objectives

The objectives of this study were to discuss the clinical magnifications and therapies of tracheobronchial foreign body aspiration (FBA) in children causing life-threatening complications.

Method

We retrospectively reviewed 38 cases of FBA with serious complications in children out of 749 cases of FBA in children that had been admitted to and treated in the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China, from June 1990 to December 2007. The complications included pneumothorax (14 cases); pneumomediastinum (6 cases); pulmonary abscess (7 cases); massive hemorrhage, tracheoesophageal fistula and exudative pleurisy, in 3 cases, respectively; and heart failure (2 cases). Each child's symptoms, including duration, physical findings, chest radiographs, including CT, and the nature of the foreign body causing the complications due to FBA were recorded.

Results

Among the 38 cases of FBA, the FBs in 36 cases were removed by bronchoscopy, and in 2 cases the FBs were removed via thoracotomy. Except for 1 case that resulted in death, the other 37 children were completely cured and discharged to home from the hospital.

Conclusions

For children with FBA who experience severe and life-threatening complications from FBA, our recommendation is that emergency measures should be available during FBs removal. With correct judgment and management of the complications of FBA, the mortality rate can be reduced.

Introduction

Tracheobronchial FBA is common among infants and pre-school children and is a frequently occurring emergency in Pediatric Otorhinolaryngology. Approximately 500 children die of FBA each year in the US, and 40% of lethal accidents among children under 1 year of age were caused by FBA [1]. With the improvement in the diagnosis and the treatment technologies of FBA, the deaths from FBA have decreased dramatically. According to the medical record statistics of the Second Xiangya Hospital, Central South University, dated from June 1990 to December 2007, 38 FBA cases with FBA-related serious complications among a total of 749 FBA cases were treated in the hospital. Out of the 38 cases, 37 were successfully treated. By the case study, the diagnoses and treatment of the 38 special FBA cases were summarized in this article.

Section snippets

Clinical data

Among 38 children with serious complications caused by FBA, 21 were boys and 17 were girls, the age range was 8 months to 8 years. The course of FBA prior to diagnosis was 2 days to 3 years. The FBs in the 38 cases included: peanuts, watermelon seeds, chestnuts, pen caps, pieces of pork and chicken bones, deciduous teeth, pins, a whistle, a steel ball and an apricot stone, a piece of cooked placenta, a plastic toy and an eraser. The locations of the FBs were: the left main bronchus (10 cases);

Results

Among the 38 children with FBA and severe complications, 37 cases including 2 cases of massive hemorrhage were cured, 1 case with massive hemorrhage died. The child who died first underwent thoracotomy, partial resection of the FB-lodged segment of the left inferior lobar bronchus and end-to-end anastomosis. After the surgery the child had anastomotic stoma stenosis and serious infection, and then underwent a second thoracotomy and left inferior lobectomy. Unfortunately the child died

Discussion

Tracheobronchial FBA is a common emergency in Otorhinolaryngology. Chiu et al. [3] pointed out the factors for the early diagnosis of FBA in children, and the FBA treatment principle to extract FBs as early as possible. Whether or not FB removal should be done after children are admitted to hospitals depends on their conditions. Generally, there were three situations when the said 749 children with FBA were hospitalized: (1) some of them already had III degree dyspnea or above, and complicated

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Cited by (20)

Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011–2018
2019, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
However, it is not the first choice for those child patients. Because although bronchoscopy is generally simple and safe in child patients, serious complications such as pneumothorax, tracheal laceration, pneumonia, subglottic edema and death may occur, even when practiced by physicians with many years of experience [1,9,10]. In addition, the correct identification of the exact location, form, and volume of the FB which can be often revealed by MDCT or 3D imgaes based on MDCT is beneficial for performing rigid bronchoscopy, which can not only reduce the surgery time, but also decrease the occurrence rate of complications.
This study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy.
The medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema.
Of the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7–156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups.
Foreign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.
61 - Diffuse Alveolar Hemorrhage in Children
2019, Kendig's Disorders of the Respiratory Tract in Children
Diffuse alveolar hemorrhage most commonly refers to bleeding from the low-pressure pulmonary vascular bed and is a rare cause of chronic interstitial lung disease in children. Patients can present acutely with respiratory failure or more indolently with a history of worsening exercise intolerance and cough. Diffuse alveolar hemorrhage is divided into two broad categories: immune mediated and nonimmune mediated with immune-mediated hemorrhage being more common. The most common causes of immune-mediated diffuse alveolar hemorrhage are the ANCA-associated vasculitidies and idiopathic pulmonary capillaritis. It is important to distinguish between immune and nonimmune causes of hemorrhage, such as idiopathic pulmonary hemosiderosis, as treatment is significantly different.Regardless of the cause of alveolar hemorrhage patients most often present with diffuse infiltrates on chest x-ray and anemia. Chest CT scan is very useful in establishing a diagnosis and most often reveals diffuse ground glass opacities and septal thickening or nodules. Bronchoscopy and bronchoalveolar lavage are used to establish pulmonary hemorrhage. A lung biopsy is necessary in any patient with diffuse hemorrhage and negative ANCA to help distinguish between immune- and nonimmune-mediated hemorrhage.Treatment of diffuse alveolar hemorrhage is dependent on the type of hemorrhage. Immune-mediated hemorrhage requires aggressive immune suppression to halt progression of the disease. Nonimmune-mediated hemorrhage is managed with much less immune suppression.
The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration
2017, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Foreign body aspiration (FBA) is a serious and common health problem in childhood which could cause significant morbidities and even mortality [1–5].
Foreign body aspiration (FBA) could be a serious life-threatening condition in children. Patients usually underwent bronchoscopy with suspicious of FBA alone. In this study, we aimed to determine which patients need to go to bronchoscopy based on pre-operative findings.
Retrospective analysis of patients underwent bronchoscopy between 1999 and 2015 was performed. Clinical symptoms, witnessed aspiration event (WAE), physical examination findings (PEFs) and radiological findings (RFs) were analyzed by multivariate analysis to evaluate the indications of bronchoscopy.
431 patients (266M, 165F) underwent bronchoscopy with a median age of 2 years (7 months-16 years). A foreign body was detected in 68% of the patients. Univariate analysis demonstrated that wheeze was the sole distinctive clinical symptom for detection of FBA (p<0.001). The rates of positive WAE, PEFs and RFs were 83%, 71.7% and 36.9%, respectively. All of them were identified as independent predictive parameters in the detection of FBA by univariate analysis (p = 0.003&p<0.001&p = 0.015). Multivariate analysis was performed with considering the association between them. The rate of positive bronchoscopy was 91.3% in patients with positive WAE, PEFs and RFs together(84/92). In patients with a positive WAE alone who had not got PEFs and RFs, the rate of positive bronchoscopy was 34.2% (25/73). A foreign body was detected in 84% of the patients who had not got a WAE but positive PEFs and RFs together(21/25). Bronchial laceration was occurred in one patient during bronchoscopy. Pneumothorax was not seen in any of the other patients. The rate of mortality was 0.4% in the overall group (2 patients).
The indications of bronchoscopy in suspected FBA are usually based on clinical suspicious. The definition of “ suspicous” could be a WAE or positive PEFs and RFs. The association of these factors increase the rate of positive bronchoscopies. In the light of our study, the classical indication for suspected FBA is still valid as “suspicious requires bronchoscopy”.
Tracheobronchial Foreign Bodies in Children: Imaging Assessment
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Citation Excerpt :
Pneumothorax is a relatively rare complication of foreign-body aspiration. In a study of 749 children with foreign-body aspiration, pneumothorax was seen in 1.9% of the cases.22 Pneumothorax can occur during the time of foreign-body inhalation.
Tracheobronchial foreign-body aspiration is a relatively frequent pediatric emergency and a cause of substantial morbidity and mortality especially in preschool children. Although foreign-body aspiration may cause sudden airway obstruction and subsequent death, quite often symptoms are mild and nonspecific; therefore, the correct diagnosis may be delayed particularly in the pediatric population. A delay in diagnosis increases the rate of complications and can cause substantial morbidity. Early and accurate diagnosis combined with intervention through foreign-body retrieval is critical for proper patient management. For evaluation of both radiopaque and non-radiopaque airway foreign bodies in pediatric patients, imaging plays an important role in initial detection and follow-up evaluation. In this article, we discuss the currently available imaging modalities and techniques for evaluating tracheobronchial foreign bodies in infants and children. Imaging findings of various tracheobronchial foreign bodies and mimics of foreign bodies are also discussed. In addition, information regarding management of tracheobronchial foreign-body aspiration is included.
Application of Imaging Guidelines in Patients With Foreign Body Ingestion or Inhalation: Literature Review
2015, Seminars in Ultrasound, CT and MRI
Citation Excerpt :
Inhalation of FBs is frequent among infants and preschool children. It has been estimated that approximately 500 children die each year in the United States owing to inhalation of FBs.1 Complications associated with a delayed diagnosis are pneumonia, atelectasis, bronchiectasis, and bronchial fistula.2,3
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.
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Review articleTreatment of 38 cases of foreign body aspiration in children causing life-threatening complications

Abstract

Objectives

Method

Results

Conclusions

Introduction

Section snippets

Clinical data

Results

Discussion

Int J Pediatr Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

Otolaryngol.-Head Neck Surg.

Chest

Ann. Chir.

J. Pediatr. Surg.

Review article
Treatment of 38 cases of foreign body aspiration in children causing life-threatening complications