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Iranian Journal of Pediatrics
Tehran University of Medical Sciences Press
ISSN: 1018-4406 EISSN: 2008-2150
Vol. 18, Num. 2, 2008, pp. 191-192

Iranian Journal of Pediatrics, Vol. 18, No. 2, June, 2008, pp. 191-192

Foreign Body Aspiration: A five-year Report in a Children's Hospital

Aliakbar Rahbarimanesh*1, MD, Pediatric Infectious Diseases Specialist; Elaheh Noroozi2, MD, Resident in Pediatrics; Mansour Molaian3, MD, Pediatric Surgeoun; Piman Salamati4, MD, Community Medicine Specialist

1Bahrami Children's Hospital, Tehran University of Medical Sciences, IR Iran
* Correspondence author; Address: Bahrami Children’s Hospital, Damavand Ave, Tehran, IR Iran E-mail: elahe_norouzi@yahoo.com

Received: 16/06/07; Revised: 15/10/07; Accepted: 17/11/07

Code Number: pe08033

Airway foreign bodies as a preventable event have been a major cause of morbidity and mortality, resulting in 500-3000 deaths annually.[1] Foreign body aspiration may result either in airway compromise and death or in serious sequels such as recurrent pulmonary infections, atelectasis, or bronchiectasis[2]. To prevent these complications, prompt diagnosis and removal of the foreign body is mandatory.

We performed a case series study on 44 children diagnosed as having foreign body aspiration, aged 15 years or younger, attending Bahrami Children's Hospital in Tehran from October 2001 to October 2006. On the basis of history, physical examination and imaging findings they all underwent rigid bronchoscopy and foreign body removed from their airways. The authors recorded children's age and sex, the results of physical examination, imagings and bronchoscopic findings (type and site of foreign body, airway injury), primary clinical diagnosis, and the time relapsed between aspiration and removal of the foreign body.

The prevalence of foreign body aspiration was highest in children under 3 years of age (77%) and more common in boys (64%). This is in concordance with other studies[3]. The high incidence in young children reflects their tendency to explore their world using their mouths. Furthermore, these children have not yet developed a full posterior dentition, and neuromuscular mechanisms for swallowing and airway protection may not be fully mature.

In most studies, the most common reported symptoms and signs are choking and unilateral decreased breath sounds[4].

In present review, as indicated in table 1, the most common symptom was coughing (82%), followed by choking (57%). In addition, 9% had normal findings in their physical exam. We conclude that in absence of choking, bronchoscopy should be preformed if there is evidence of foreign body aspiration.

Table 1- Signs and symptoms found in children with foreign body aspiration in Bahrami Children's Hospital 2001-2006

Symptom/sign

Frequency* (%)

Coughing

36 (82)

Choking

25 (57)

Wheeze

15 (34)

Dyspnea

10 (23)

Cyanosis

2 (5)

Wheezing

18 (41)

Fever

13 (30)

Decreased breath sounds

2 (27)

Tachypnea

9 (20)

Crackle

7 (16)

Stridor

2 (5)

Normal exam

4 (9)

* In some patients, more than one finding was found

In previous studies, 34% [5] to 63% [6] of cases had a delayed bronchoscopy as a result of misdiagnosis, usually pneumonia. In present study, the primary clinical diagnosis in 29 cases (66%) was foreign body aspiration, 13 pneumonia, 1 asthma and 1 laryngitis.

This indicates necessity of awareness of physicians about symptoms and signs of foreign body inhalation and patient follow up to prevent later complications, delayed treatment and cost waste.

The common site of foreign body in patients' bronchoscopy in previous studies often was right main bronchus (34% to 67%) [7,8], which is due to the larger diameter of right main bronchus, the smaller angel of divergence from tracheal axis on the right and the greater airflow through the right lung. In contrast, Cleveland[3] has reported that in children the left main bronchus has quite the same diameter with the right one. In our study, foreign body was lodged in left main bronchus in 45% of patients and in right in 43% of them, which is not considerably different and further studies with more samples are needed to establish whether there's true difference between the two bronchi.

The time lapsed between aspiration to removal of foreign body by bronchoscopy in 2 (4%) cases was less than 24 hours, and in 86% of cases bronchoscopy was performed 24 hours after aspiration, which is, according to many studies, associated with high risk of mortality and morbidity[9].

With respect to the limited number of our cases, we suggest that similar multicenter studies with more cases be preformed .In addition, according to findings of this study, awareness of physicians and pediatricians in approach to patients with foreign body aspiration is of utmost importance. Furthermore, bronchoscopy must be performed in suspected cases even with normal physical examination and imaging findings.

References

  1. Holinger LD. Foreign bodies of the airway. In: Behrman RE, Kleigman RM, Jenson HB. Nelson Textbook of Pediatrics. 17th ed. 2004. Pp: 1410-1.
  2. Darrow DH, Holinger LD. Foreign bodies of the larynx, trachea, and bronchi. In: Bluestone CD, Stool SE, Kenna MA. Pediatric Otolaryngology. 3rd ed.  Philadelphia; WB Saunders. 1996; Pp: 1390-401.
  3. Cleveland R.H. Symmetry of bronchial angels in children. Radiol. 1979;133(1): 89-93.
  4. Erikci V, Karacay S, Arikan A. Foreign body aspiration: A four–years experience. Turkish J Trauma Emerg Surg. 2003; 9(1):45-9.
  5. Murray AD. Foreign bodies of the airway. eMed, Avalable at: www.emedicine.com/ ent/TOPIC451.HTM. Acess date: Oct 9, 2007.
  6. Oguz F, Citak A, Unuvar E, et al. Airway foreign bodies in childhood. Int J Pediatr Otorhinolaryngol. 2000;52(1):11-6.
  7. Ramirez-Figueroa JL, Gochicoa-Rangel LG, Ramirez-San Juan DH, et al. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol 2005;40(5):392-7.
  8. Sersar S.I, Rizk WH, Bilal M, et al. Inhaled foreign bodies: Presentation, management and value of history and plain chest radiography in delayed presentation. Otolaryngol Head Neck Surg. 2006;134(1):92-9.
  9. Skoulakis CE, Doxas PG, Papadakis CE, et al. Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases. Int J Pediatr Otorhinolaryngol. 2000;53(2):143-8.

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