Dr. Terencia, Dr Sajith Kesavan, Dr Greeshma, Dr. C Jayakumar AIMS Kochi
Ten year old female presented with accidental aspiration sewing needle at 8pm on 14/1/2023. Xray done showed the needle in the Right lower lobe, they were counselled about the risks involved in its retrieval. Hence parents sought care at our Centre
Child was not in a state of distress or shock due to bleed from the needle
Child was maintaining saturation of 98 %in room air
Symmetrical normal air entry appreciated
Labs CRP-0.22mg/L, normal CBC
Preop serology-negative
Chest Xray showed needle in right lower lobe of lung-
CT-PA with 3d reconstruction was done, which showed Linear metallic density foreign body is seen in lateral basal segment of right lower lobe of lung.
After PAC clearance-Fluroscopy guided Bronchocopy was done under GA and needle was removed. Child remained stable post procedure and was discharged with hemodynamically stable vitals.
Foreign body aspiration (FBA) is a potentially life-threatening event because it can block respiration obstructing the airway, there impairing oxygenation and ventilation.
FBA in children may be suspected on the basis of a choking episode if such an episode is witnessed an adult or remembered the child.
In contrast, the clinical presentation of unwitnessed FBA may be subtle, and diagnosis requires careful review of the history, clinical assessment, and the judicious use of radiography and bronchoscopy.
The sequence of evaluation and management depends on the clinical characteristics of the patient at presentation and during the initial work-up.
Patients with complete or impending airway obstruction move immediately to intervention, whereas stable patients with suspected foreign body aspiration (FBA) undergo further evaluation, as described below.
Commonly aspirated FBs in children include peanuts, popcorn, food particles, hardware, and pieces of toys. Food items are the most common items aspirated infants and toddlers, whereas nonfood items (eg, coins, paper clips, pins, pen caps) are more commonly aspirated older children.
The majority of aspirated FBs in children are located in the bronchi. Laryngeal and tracheal FBs are less common. In a large case series of FBA aspirations in children, the sites of the FB were as follows:
●Larynx – 3 percent
●Trachea/carina – 13 percent
●Right lung – 60 percent (52 percent in the main bronchus, 6 percent in the lower lobe bronchus, and <1 percent in the middle lobe bronchus)
●Left lung – 23 percent (18 percent in the main bronchus and 5 percent in the lower bronchus)
●Bilateral – 2 percent
A history of choking is highly suggestive of FBA, even if it occurred days or weeks before presentation. The episode may be immediately followed respiratory symptoms or there may be a symptom-free period, which must not be misinterpreted as a sign of resolution, since it may delay the diagnosis. The absence of choking history does not rule out FBA, since choking events may be unwitnessed or unrecalled.
Foreign body aspiration (FBA) should be suspected in children who have sudden onset of lower respiratory symptoms or those who have same site recurrent pneumonia
The risk is highest in children between one and three years of age
FB removal – We suggest rigid rather than flexible bronchoscopy for removal of most aspirated FBs in children. This procedure should be performed an experienced operator. Flexible bronchoscopy is also used to remove the FB in some centers with high levels of experience in this technique.
Take home message- If FBA is diagnosed soon after the event, there is usually little damage to the airway or lung parenchyma. Complications such as atelectasis, postobstructive pneumonia, or bronchiectasis may develop if the diagnosis is delayed. It is important to anticipate a FBA when a young child is brought with history of choking episode, respiratory distress, same site recurrent pneumonia,