Comparison between tracheal foreign body and bronchial foreign body: a review of 1,007 cases.

OBJECTIVE: To determine the differences between tracheal foreign body aspiration and bronchial foreign body aspiration.

METHODS: This retrospective study includes 1007 patients with the diagnosis of foreign body aspiration according to rigid bronchoscopy. Patients were divided into two groups: tracheal and bronchial foreign body groups. Age, sex, clinical presentation, pre-operative radiographic findings, rigid bronchoscopy findings, types of foreign body, and the complications of each group were observed and analyzed.

RESULTS: Out of 989 study patients, there were 146 patients (14.5%) in the tracheal foreign body group and 843 patients (83.7%) in the bronchial foreign body group. Eighteen patients with FBs located in the larynx and presenting with multiple FBs located in the tracheal and bronchial regions were excluded from this study. The majority of the patients were under the age of three for both groups. The male to female ratio was significantly higher in the bronchial foreign body group (P<0.001). More patients in the bronchial foreign body group were misdiagnosed upon first clinical visit (P=0.001), referred from another hospital (P<0.05), or had delayed diagnosis (P<0.05). The most prominent symptom in both groups was cough, followed by decreased breath sounds, wheezing, and dyspnea. More patients in the bronchial foreign body group experienced decreased breath sounds (P<0.001), while more patients in the tracheal foreign body group experienced dyspnea (P<0.05). Chest fluoroscopy abnormalities were observed at a higher frequency in the bronchial foreign body group (P<0.001). Lateral neck X-ray results showed higher frequencies of abnormalities in the tracheal foreign body patients. Out of 30 patients in the tracheal foreign body group received a CT scan, 27 had abnormal scan results, while all 253 patients in the bronchial foreign body subgroup had abnormal results. The majority of foreign bodies were organic materials and were removed by rigid bronchoscopy at the first clinical session in 96.6% of tracheal foreign body cases and 96.0% of bronchial foreign body cases (P=0.727). Major complications, including one death, were observed only in the bronchial foreign body group.

CONCLUSIONS: The nature of tracheal foreign body aspiration is different from bronchial aspiration. Clinical presentation and pre-operative radiographic findings are helpful for diagnosis. The clinician should understand the differences between tracheal and bronchial FB cases and provide the appropriate management when either is presented.