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Occult Foreign Body Aspirations in Pediatric Patients

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Occult Foreign Body Aspirations in Pediatric Patients Liu et al. BMC Pulm Med (2020) 20:320 https://doi.org/10.1186/s12890-020-01356-8 RESEARCH ARTICLE Open Access Occult foreign body aspirations in pediatric patients: 20-years of experience Bo Liu1,2* , Fengxia Ding3,2, Yong An1, Yonggang Li1, Zhengxia Pan1, Gang Wang1, Jiangtao Dai1, Hongbo Li1 and Chun Wu1 Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difculties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our depart- ment. Thirty-fve patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n 25, 71.4%). Coughing (n 35, 100%) and wheezing (n 18, 51.4%) were the main symptoms and signs. All the patients= were found to have a= FBA under the fberoptic bronchoscope.= The most common organic foreign bodies were pea- nuts (n 10) and the most common inorganic foreign bodies were pen caps (n 5). The extraction of foreign bodies under rigid= bronchoscopy was applied successfully in 34 patients. Only one patient= needed a surgical intervention. Conclusions: Occult FBA should always be considered in the diferential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration. Keywords: Occult, Foreign body, Paediatrics Background cough or roaring occurs immediately after inhaling a for- Foreign body aspiration (FBA) is a common and serious eign body (FB). Subsequent chronic symptoms such as health problem in childhood. It has a high incidence and cough, wheezing, stridor, fever, shortness of breath, and can even be life-threatening [1]. Children under 3 years of dyspnea often trigger the guardian’s alert so that the child age are most vulnerable to FBA, which is related to their can be promptly diagnosed and treated. narrow airways and immature protective neuromuscular However, in very few cases, symptoms are mild or mechanisms [2]. Most of them can be suspected of hav- undetected after aspiration of the foreign body and the ing a defnite history of aspiration. In general, irritating foreign body can stay in the bronchi for months or even years. Te clinical symptoms and signs caused by for- eign bodies are often not specifc and the imaging signs *Correspondence: [email protected] are also not obvious. Tis type of FBA is difcult to dis- 1 Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National tinguish from diseases such as lung infections, asthma, Clinical Research Center for Child Health and Disorders; China and congenital airway stenosis, which easily leads to International Science and Technology Cooperation base of Child missed diagnosis or misdiagnosis. Bronchoscopy is often development and Critical Disorders, Children’s Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, required to detect the presence of foreign bodies. Such Chongqing 400014, China cases are called prolonged, suspected, or occult FBA [3– Full list of author information is available at the end of the article 5]. Asymptomatic or long-standing occult FBA can cause © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liu et al. BMC Pulm Med (2020) 20:320 Page 2 of 6 irreversible complications such as bronchiectasis, bron- patients, 71.4%). Te average course was 3.69 months chopleural fstula, recurrent pneumonia, lung abscess, (range 4 days-4 years). atelectasis and even death [1]. Tese patients were misdiagnosed with pneumonia, Up to now, there is a lack of related research on chil- asthma, tuberculosis, and bronchitis as out-patient. dren with occult FBA. In order to strengthen the under- Among the teaching attending rounds, the frst diagnosis standing of its clinical characteristics, analyze diagnosis was pneumonia (30 cases, including 10 cases of persis- and treatment experience, and explore diagnostic ideas, tent pneumonia, 4 cases of chronic pneumonia, 4 cases the cases of occult FBA diagnosed in the Children’s Hos- of severe pneumonia), 3 cases of asthma (including 2 sus- pital of Chongqing Medical University were retrospec- pected cases), 1 case of bronchitis, and 1 case of bron- tively analyzed. chiectasis. Suspected diagnoses were FBA (20 cases), tuberculosis (13 cases), asthma (11 cases), bronchiectasis Methods (7 cases), bronchopulmonary dysplasia (6 cases), and idi- We retrospectively evaluated the medical records of 35 opathic pulmonary hemosiderosis (2 cases). hospitalized patients who underwent bronchoscopy due All patients denied the history of FBA. All the 35 to occult FBA in the Children’s Hospital of Chongqing patients had diferent degrees of cough and there was no Medical University from May 1, 2000 to May 1, 2020. Te obvious tracheal deviation or tracheal tapping sounds on study was approved by the ethics committee of the Chil- physical examination. Te most common positive sign dren’s Hospital of Chongqing Medical University (2019– was wheezing (18 cases) and 7 patients had negative signs 48). As there is no precise defnition of occult FBA, (Table 1). relevant literature [6, 7] was referred to, as well as com- In laboratory tests, the results of blood routine showed bined with our own data, to defne the following inclu- an increase in white blood cell (WBC) count in 25 cases, sion criteria: (1) Denies the history of FBA, (2) no typical mainly with an increase in neutrophil count. C-reactive clinical symptoms of FBA such as irritating cough; only protein (CRP) increased in 8 patients. Fourteen cases fever, cough, wheezing and other non-typical symptoms were positive for sputum bacteria culture (one case of existed, (3) no tracheal deviation was found on palpa- co-infection), six cases were positive for virus antibodies tion, no tracheal tapping sound was found on ausculta- (one case was co-infection), and two cases were positive tion, and (4) no FBs were found on radiological fndings. for the specifc DNA of mycoplasma pneumoniae (MP). Children with suspected FBA but negative bronchoscopy Sputum smear and culture of tuberculosis were negative were excluded. Te following individual case data were (Table 1). recorded: Radiological fndings after admission showed that no direct signs of FB. Occult FBAs are mainly manifested – Age and sex, in pneumonia, atelectasis, and lung consolidation on the – Course of the disease and time between the admis- basis of images (Table 1). sion and the bronchoscopy, Tirty-fve patients were treated with bronchoscopy – Chief complaint and summary of history, physical and alveolar lavage for long-term symptoms, abnor- examination, laboratory tests, and radiological fnd- mal radiological fndings, and poor treatment outcomes ings, (Fig. 1). Te time from admission to undergoing bron- – Diagnosis on admission and diagnosis on discharge, choscopy for diagnosis of FBA was 1–18 days (average – Treatment measures, 3.26 days). All the patients were found to have FB under – Endoscopic fndings: FB nature, location, and com- the fberoptic bronchoscope (two cases were found by plications related to FB, repeated fberoptic bronchoscopy). Nineteen cases were – Complications related to the endoscopic procedure, located in the main bronchus, 12 cases were located in – Immediate and short-term follow up after removal. the lobar bronchus, and 4 cases were located in the seg- mental bronchus. Patients underwent rigid bronchoscopy (Karl Storz GmbH & Co KG, Tuttlingen, Germany) for Results FBs extraction under combined intravenous anesthesia From May 1, 2000 to May 1, 2020, 3557 patients under- with airway surface anesthesia. Te position of FBs in 30 went bronchoscopy and were defned diagnosed as FBA patients remained consistent under rigid bronchoscopy in our department. Of these patients, 35 (0.98%) met the and the position changed in 5 patients. Te location of inclusion criteria for occult FBA. 23 (65.7%) were male the FBs in the tracheobronchial tree is shown in Table 2. and 12 (34.3%) were female, and the M: F ratio was 1.92:1. After bronchoscopy, 8 patients had a transient fever, 6 Te average age was 3.60 years (range 9 months-12 years). patients presented as slightly irritable, and
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