Foreign bodies in the airway: a quarter of a century's experience.

INTRODUCTION: Foreign body (FB) aspiration in children is a common and potentially dangerous situation that can be associated to significant morbidity.

AIMS: To characterise the FB aspiration in children cases at the Hospital Pediátrico de Coimbra over a twenty five year period.

STUDY DESIGN: This study was based on the retrospective analysis of all clinical files of children who were diagnosed with foreign body aspiration January 1982 to December 2006.

RESULTS: Foreign body aspiration was confirmed in 316 children. The incidence was higher during the first twelve years of the study (64%). Around two thirds of the children were male (206) and the sample was aged 6 months to 12 years. Most children were younger than 3 years old (83%). In 88% of cases a choking episode was noticed while an early diagnosis (<24h) was obtained in only 39%. The most frequently described signs and symptoms were unilateral diminished breath sounds and cough. In 7% of cases no symptoms were described. The most frequently recorded radiology finding was focal hyperinflation (42%) and in 22% the chest x-ray was unremarkable. Treatment was exclusively by rigid bronchoscopy. Complications related to the bronchoscopy removal were described in 22 cases. Most aspirated FB were of vegetable origin (75%). The majority of FB was lodged in the right bronchial tree. Postremoval flexible bronchoscopy was performed in 116 cases.

CONCLUSION: An unnoticed FB aspiration and absence of and/or non-specific initial symptoms may contribute to a late diagnosis. The significant reduction in the number of cases over the later years may be related to the implementation of preventive strategies.