PURPOSE: To examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FB) according to risk of aspiration and the outcomes of intervention by fiberoptic bronchoscope.
METHODS: From December 1994 through December 2004 at Kyung Hee Medical Center, the medical records of 29 adult patients with FB identified by fiberoptic bronchoscope were restrospectively analyzed.
RESULTS: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and were at high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients including each 3 and 4. Respiratory symptom(s) were noted in 22: cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%), and hemoptysis (0.4%). Only 60% of those at high risk of aspiration had symptom(s) (92.8% of those without risk of aspiration, p=0.005). Those at risk of aspiration had longer duration of symptom (median 4 days vs 2 days, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration was more frequent in those without risk of aspiration (9 vs 4, p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients: 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 the medical procedures (57.1%, in patients at risk) and diet (35.7%, in patients without risk). Most common FB materials were tooth (n = 11). Alligator jaw biopsy forceps (n = 23) was the equipment used most commonly. All of FB were removed without significant complications.
CONCLUSION: This study showed that tracheobronchial FB of the patients at high risk of aspiration are more likely to overlooked because of lack of specifity and more gradual onset of symptoms and develop iatrogenically in many cases.
CLINICAL IMPLICATIONS: In the patients with non-specific respiratory symptoms and at high risk of aspiration, tracheobronchial FB should not be overlooked.
DISCLOSURE: Jee-Hong Yoo, No Financial Disclosure Information; No Product/Research Disclosure Information