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Clinical indications for bronchoscopy
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Katelyn Krivchenia, Meredith Merz Lind
Foreign body aspiration into the airway can be life-threatening and may not be witnessed or suspected, especially in a young child. History, physical examination, or imaging studies may raise concern for possible aspirated foreign objects, although the gold standard for diagnosis of this condition is with rigid bronchoscopy, and a high index of suspicion is essential so that diagnosis is not missed. In addition to diagnosis, therapeutic intervention can be immediately performed with rigid bronchoscopic equipment (Figure 1.10). Foreign bodies can become lodged at any point in the airway, including in the pharynx, glottis, trachea, or, most commonly, the bronchi (Figure 1.11). Various equipment can be used to access and remove foreign objects located at any point in the airway down to the first or second bronchial divisions. Endoscopists should be intimately familiar with their equipment and its function in order to care for these patients efficiently and safely. More distal objects might be accessed with flexible bronchoscopy, and, in very rare cases, open surgery may be required to remove a foreign body.
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Foreign body aspiration is a common cause of accidental morbidity and mortality in children under the age of 5 years. In adults, the major causes of foreign body inhalation are altered mental status (sedative use, alcohol, trauma), advanced age (>70 years) and impaired cough reflex (stroke, epilepsy, Parkinson’s disease).
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Symptoms of foreign body aspiration include acute apnoea if the foreign body is lodged in the larynx or trachea, severe respiratory distress if the foreign body is lodged in a major bronchus, wheezing when the obstruction is partial, and signs of consolidation when there is superadded infection. Most foreign respiratory bodies are food (and therefore are not radio-opaque) and occur in children below the age of 4 years.
Removing endobronchial needle-like foreign bodies in two school-age children
Published in Acta Oto-Laryngologica Case Reports, 2023
Case 1 was a nine-year-old boy who was initially admitted due to a persistent cough that lasted over half a month and a fever persisting for four days. The child denied any history of foreign body aspiration. Physical examination revealed a temperature of 38.9 °C, diminished breath sounds, and rales in the right upper lung region. Right upper lobe pneumonia and atelectasis were seen on a chest CT due to a needle-like metallic foreign body lodged in the right main bronchus and upper lobe bronchus (Figure 1) The CT scan confirmed that the foreign body was located in the right upper lobe bronchus, a position rarely encountered in clinical practice. Despite the child’s denial of any history of foreign body aspiration, the diagnosis of an endobronchial foreign body was considered based on the patient’s symptoms and CT findings. We decided to perform a rigid bronchoscopy examination and foreign body removal under general anesthesia (Figure 2).
Iron pill pneumonitis with reactive lymph nodes
Published in Baylor University Medical Center Proceedings, 2018
Letlhogonolo Tlhabano, Rohan Mankikar, Chibuzo Odigwe, William Owens, Lawrence Grant, Rohan Arya
The diagnosis of pill aspiration should always be considered in patients, especially those with unexplained pulmonary symptoms or recurrent pneumonia. Patients may not always have the classic risk factors and may not recall the aspiration event. Patients may also present with anorexia, cough, hemoptysis, pleuritic chest pain, wheezing, night sweats, and fever.2–8 Early complications of foreign body aspiration may include choking, acute dyspnea, laryngeal edema, asphyxiation, pneumothorax, and cardiac arrest.9–15 Late complications include hemoptysis, bronchiectasis, bronchial stricture, development of inflammatory polyps, diminished perfusion to the lung, pneumonia, empyema, and death.7
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
Foreign body aspiration always represents a serious situation that may put a child at risk of severe complications, sequelae, or even death. Any signs or signals of possible aspiration must be taken seriously, and child should proceed to medical evaluation. Whenever in doubt, bronchoscopy should be performed to exclude or confirm FBA, possibly using the flexible bronchoscope. Risks and burden of bronchoscopy are always much lower than a risk of neglected foreign body and sequelae that this may cause.