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Kim, Choi, Choi, Park, Kang, and Yoo: Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 64(5): 356-361.

Published online: 31 May 2008

DOI: https://doi.org/10.4046/trd.2008.64.5.356

Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration

Yee Hyung Kim, M.D.1, Cheon Woong Choi, M.D.1, Hye Sook Choi, M.D.3, Myung Jae Park, M.D.2, Hong Mo Kang, M.D.2, Jee-Hong Yoo, M.D.1

1Department of Pulmonary and Critical Care Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.

2Department of Pulmonary and Critical Care Medicine, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.

3Department of Pulmonary and Critical Care Medicine, Dongguk University College of Medicine, Gyeongju, Korea.

Address for correspondence: Jee-Hong Yoo, M.D. Department of Pulmonary and Critical Care Medicine, East-West Neo Medical Center, Kyung Hee University, 149, Sangil-dong, Kangdong-gu, Seoul 134-727, Korea. Phone: 82-2-440-7701, Fax: 82-2-440-7707, honglung@chol.com

Received 14 April 2008       Accepted 24 April 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

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.

Keywords: Foreign body, Aspiration, Flexible bronchoscope

Figures and Tables

Table 1
Clinical characteristics of patients with tracheobronchial foreign bodies (n=29)
trd-64-356-i001

*Splinters of a shell aspirated accidently in the period of Korean war was noted in 78-year old male without risk of aspiration. This case was excluded from the analysis of duration of symptom.

Table 2
The locations of aspirated foreign bodies (n=29)
trd-64-356-i002

RLL: right lower lobe; RUL: right upper lobe; BI: bronchus intermedius; RML: right middle lobe; LLL: left lower lobe; LUL: left upper lobe.

Table 3
The types of tracheobronchial foreign bodies (n=29)
trd-64-356-i003
Table 4
The cases of aspiration into tracheobronchial trees in adults (n=29)
trd-64-356-i004
Table 5
The equipments used to remove foreign bodies
trd-64-356-i005

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