Non-asphyxiating tracheobronchial foreign bodies in adults

Abstract

The presentations of 47 adult patients with a non-asphyxiating tracheobronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine ('acute group'); 1 month or more in 29 ('chronic group'), uncertain in four ('uncertain group'); and the foreign body was a broncholith in five patients ('broncholith group'). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient. Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients. The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to 'suspicion of an endobronchial lesion' were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.