Study of tracheo-bronchial foreign bodies presentation, diagnosis & management at tertiary care center

Abstract

Background: Tracheobronchial foreign body (TFB) aspiration is a serious medical problem
associated with significant morbidity and mortality. Tracheobronchial foreign body (TFB)
may lead to serious complications such as airway inflammation, hemoptysis, bronchiectasis,
pulmonary atelectasis, and even asphyxia and death. Present study was aimed to study
tracheobronchial foreign bodies presentation, diagnosis & management at tertiary care center.
Material and Methods: Present study was single-center, retrospective study, conducted in
cases with history of aspiration, sudden onset of breathlessness or choking sensation in a
healthy person, recurrent respiratory infections with clinical or radiological evidence, and
suspicion of foreign body & later had confirmed evidence of TFB. Results: 52 cases
satisfying study criteria were studied. Majority were children below 2 years of age (40.38 %)
, followed by 3-4 years age group (30.77 %). Majority of cases were male (59.62 %) as
compared to female (40.38 %). Majority of cases had symptoms or history of dry cough
(63.46 %), noisy breathing (51.92 %), respiratory distress (46.15 %) & witnessed choking
(26.92 %). While among signs majority of cases had unilateral reduced air entry (53.85 %),
unilateral wheeze (40.38 %), whistling and clicking sounds (21.15 %) & no signs (17.31 %).
Chest X-Ray findings were consolidation (61.54 %), lobar collapse (55.77 %), hyperinflation
(51.92 %), ipsilateral emphysema (40.38 %) & normal (15.38 %). CT Bronchogram was not
done in 44.23 %, while in cases underwent CT were findings of ? foreign body/mucus plug
(30.77 %) & foreign body (25 %). Location of foreign body was left main bronchus (53.85
%) followed by right main bronchus (34.62 %), carina (7.69 %) & left main and secondary
bronchus (3.85 %). Supari/betel nut (30.77 %) was most common foreign body observed
followed by peanut (28.85 %), ground nut (25 %), plumseed (1.92 %), coconut (1.92 %) &
non-organic (11.54 %). Intra operative granulations were present in 30.77 % cases.
Conclusion: High suspicion in patients presenting with raspy respiration, wheezing, or
coughing for tracheobronchial foreign body followed by early diagnosis as well as
therapeutic measures with help of rigid/flexible bronchoscopy under expert supervision can
prevent morbidity & mortality related to tracheobronchial foreign body aspiration.