Categories
Foreign Body Aspiration
Dec 07, 2022
Case - 1
4 years girl presented with fever and cough since 5 days and sudden onset neck swelling since one day. Examination revealed tachypnea with surgical emphysema in the region of the neck, more on the left side and decreased air entry on the left side. X-Ray revealed subcutaneous air shadows in the neck and thoracic regions.
With the presentation of sudden onset surgical emphysema and deferential air entry, broncoscopy was done which revealed a peanut in the left main bronchus which was successfully retrieved.
Case - 2
10 months male infant presented with history of fever, cough of 5 days duration with progressively increasing distress. Examination revealed a infant with respiratory distress and decreased air entry on the left side. X-ray chest and CECT chest revealed a collapsed left upper lobe with no air bronchogram and hyperinflated left lower lobe.
Bronchoscopy revealed a thick mucous plug which had formed an airway cast and was removed.
Airway Foreign Bodies
• “Not all that wheezes is asthma!” -Dr. Chevalier Jackson
• A US National Safety Council report stated that choking caused 4,500 deaths (3000 children) in the United States every year
• In a child with sudden onset spontaneous surgical emphysema, foreign body aspiration should be suspected.
• The complete triad of coughing, wheezing, and decreased or absent breath sounds is present in only about 40% of cases
• Given the high morbidity associated with delay in the diagnosis of an airway foreign body, and the limited sensitivity of radiographic studies in identifying this condition, clinical judgment must dictate whether the child should be scheduled for diagnostic bronchoscopy in the absence of radiographic findings.
• Peanuts are the most common offending agent. Unfortunately, only 6-17% of airway foreign bodies are radio-opaque.
• Only half of all children are diagnosed correctly in the first 24 hours after an aspiration event. An additional 30% receive the correct diagnosis in the following week, while the remainder may have delays in diagnosis of weeks to years. One-fourth of children may be asymptomatic at the time of presentation, and up to 38% may have no helpful physical exam findings.
Father of Bronchoscopy: Gustav Killian
Gustav Killian is considered the founder of bronchoscopy. In 1895 he was the first to make an exploration of the bronchi with a bronchoscope, and two years later used the instrument and a forceps to successfully remove a foreign body from the windpipe. In 1908 he devised a light-reflecting laryngoscope.
For his development of bronchoscopy, Killian was proposed as a candidate for the Nobel Prize in Physiology or Medicine, but died before he was nominated.
Dr.UJJWALA DESAI
DCH, DNB (Peds), MRCPCH (UK)
Rainbow Children's Hospital, Banjara Hills, Hyderabad
