Foreign body aspiration in adult airways: therapeutic approach

Abstract

Tracheobronchial foreign body (FB) aspiration is an uncommon but potentially life-threatening event in adults. Symptoms typically consist of a choking event followed by cough and dyspnea, however, these findings are inconsistent and symptoms may mimic more chronic lung diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can provide information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. The authors describe the typical clinical presentation, diagnostic evaluation, and bronchoscopic management of foreign bodies in adult airways with a focus on bronchoscopic techniques and potential complications of FB extraction.

Keywords: Adult; aspiration; bronchoscopy; complication; foreign body (FB); technique.

Figure 1

PA chest radiograph showing a radiopaque tooth lodged in the right lower lobe (the radiopaque object on the left is a surface ECG electrode). PA, postero-anterior.

Figure 2

PA chest radiograph and CT scan of the chest showing minimal changes to the radiograph but very easily identified foreign body lodged in the right mainstem bronchus. PA, postero-anterior.

Figure 3

This CT chest easily identifies this pistachio shell in the left mainstem bronchus. This object is relatively radiolucent and was not visible on chest radiograph.

Figure 4

Rat toothed forceps with multiple broncholiths removed from a patient with history of histoplasmosis.

Figure 5

Wire snare used to extract a large airway FB. FB, foreign body.

Figure 6

An aspirated pea has been caught in a 4-wire basket (A) and an aspirated nut caught in in a 3-wire basket (B).

Figure 7

Flexible cryoprobe has been passed through this flexible bronchoscope. The area of expected cryoadherence is represented by the frozen water surrounding the tip of the probe.

Figure 8

This tooth lodged in the right mainstem (A) and was extracted leaving behind significant granulation tissue (B) that was cryoablated with repeated freeze-thaw cycles using the cryoprobe (C).

Figure 9

Cupped forceps are shown in use removing an aspirated sewing needle. The needle tip has been grasped in the forceps in order to protect the airways on extraction.