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KMID : 0383820080640050356
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Tuberculosis and Respiratory Diseases
2008 Volume.64 No. 5 p.356 ~ p.361
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Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration
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Kim Yee-Hyung
Choi Cheon-Woong
Choi Hye-Sook
Park Myung-Jae
Kang Hong-Mo
Yoo Jee-Hong
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Abstract
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Background: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign
bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope.
Methods: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope.
Results: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a
high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications.
Conclusion: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration
are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases. (Tuberc Respir Dis 2008;64:356-361)
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KEYWORD
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Foreign body, Aspiration, Flexible bronchoscope
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