Bronchial foreign bodies more common than tracheal foreign bodies in a pediatric population

Image: PD

Key findings:

  1. Foreign bodies are encountered more commonly in the bronchi (85%) than the trachea (15%).
  2. Although they can often present similarly, this study analyzed some patient characteristics that differed depending on where the foreign body was located, with many findings being statistically significant.

Primer: A foreign body (FB) can present as an airway emergency if aspirated into the respiratory tree. Children, or even adults, may aspirate peanuts, small toys, coins, or even disc batteries into their larynx, trachea, or most commonly their bronchi.  If not previously expelled by the patient before presentation, FBs can cause significant distress, stridor, vomiting, unexplained cough or even pneumonia. Bronchoscopy is most likely needed to remove the FBs.

The clinical features, epidemiology, and management of aspirated FBs have been well-documented, but most literature has pertained to bronchial FBs. This study aimed to evaluate the differences between patients presenting bronchial FBs compared to those with tracheal FBs.

For further reading, please see the following study:

  1. 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):143–148.
  2. Saki N, Nikakhlagh S, Rahim F, et al. Foreign body aspirations in infancy: A 20-year experience. Int J Med Sci. 2009) 322–328.

This [retrospective] study: This Chinese study included 1,007 patients, aged 4 months to 79 years of age, who underwent bronchoscopy after being diagnosed with a FB in the bronchus (85% of patients) or trachea (15% of patients). Patient characteristics that were studied included age, sex, clinical presentation, pre-operative radiographic findings, types of FB, and complications.

Some select findings from the study:

  • Significantly more patients with a bronchial FB were male (p<0.001);
  • Cough was the most prominent symptom in both groups; more patients in the bronchial FB group experienced decreased breath sounds (p<0.001), while more patients in the tracheal FB group experienced dyspnea (p<0.05);
  • The most commonly aspirated FBs were peanuts, watermelon seeds and sunflower seeds;
  • There was one death, in a patient with a bronchial FB; and
  • Chest x-ray abnormalities more commonly observed in the bronchial FB group, while CT scans were 100% sensitive in both groups.

In sum: The clinical diagnosis and subsequent management of patients with a suspected aspirated FB requires urgent action. Possible complications of an aspirated FB include respiratory infection, laryngeal edema, mediastinitis, pneumomediastinum, or even death. As such, it is important to be able to recognize an aspirated FB, which is commonly mistaken for asthma in children, and then to delineate the location of the FB on clinical and radiographic examination.

Limitations of the study include its retrospective nature and the exclusion of patients who had died from the aspirated FB before reaching hospital.

Please click to read study in the International Journal of Pediatric Otorhinolaryngology

Written by [GL] and [AC]

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