Tracheobronchial foreign body aspiration: a continuing challenge.

OBJECTIVE: The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations.

STUDY DESIGN AND SETTING: Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome.

RESULTS: Seventy-eight (55.7%) patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy.

CONCLUSIONS: History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.