Clinical Analysis Of Adult Patients With Foreign Body Aspiration

Objective:To investigate the clinical features of aspirated bronchial foreign body (BFB) in adults and to improve the level of diagnosis and treatment.Methods:This was a retrospective study including27hospitalized adults who had been diagnosed with BFB in the First Affiliated Hospital of Guangxi Medical University between January2003and January2014. We analyzed the patients for gender, age, FB localization, treatment history, history of foreign body aspiration (FBs), types of foreign body. Additionally, each patient was analyzed for FB-related complication, pre-operative radiographic findings, results of bronchoscopic removal and the presence of foreign bodies in the airways.Results:1. Twenty-seven patients with airway foreign body aspiration aged from25.5to82years are recruited to our study, and had a mean age of57.7years, including nineteen males.51.8%of patients were upon the age of60years. Duration of residence of the foreign body was between four days and fifty years and its percentage of> one month was77.8%. Choking history was obvious in11patients before fiberoptic bronchoscopy.2. The common clinical symptoms were as follows:cough in all patients, expectoration in26cases, fever and dyspnea in6cases, wheezing in4cases, hemoptysis/hemosputum in5cases, chest pain in5cases.2cases had a history of CNS dysfunction due to thrombotic infarction.4cases had pulmonary diseases, including asthma with thrombotic infarction, chronic bronchitis, pulmonary tuberculosis and diffuse panbronchiolitis (DPB). Of the27adults,17had been misdiagnosed with pulmonary diseases, including pneumonia, lung caner, bronchiectasis。3. In our present study, most of the foreign bodies were organic materials, with a percentage of80.7%. However, animal bones were most common foreign bodies and had a percentage of55.6%. The remaining was plant-related matters, which consisted of2nutlets,1tablet,1groundnut,1waxberry,1plant bark. In inorganic foreign bodies, metal ring, metal false tooth, fastener liked plastic toy was found in three patients respectively.18foreign bodies were located in right bronchus. Interestingly,15of18foreign bodies were located in middle stem bronchial tree or in lower brochial tree. 4. In our study, a total of9cases were underwent chest radiography and chest X-rays were normal. Computed tomography were performed in20cases and showed shadow of foreign bodies in5cases, and suspected foreign bodies in5cases. The most common imaging manifestations were pneumonia, obstructive pneumonia and pulmonary atelectasis.5. All patients were performed flexible fiberoptic bronchoscopy. Of all bronchoscopy procedure,26foreign bodies were found. Hyperaemia and edema was to varying degrees existed in the site of retention of foreign body.22cases with duration of residence of the foreign body greater than10days had a complication of granulation proliferation. Interestingly, massive granulation proliferations were common in cases with aspiration of bone matters, and were rare in cases with aspiration of plants materials and inorganic matters. The foreign body was removed with a fibreoptic bronchoscope in over92.5%of patients.Conclusionsl. Adult patients with foreign body aspiration had a sex difference (common in male). Most common symptom was cough and expectoration. Elderly person was more likely to suffer from foreign body aspiration and had not a low percentage of delay of treatment and misdiagnosis due to a lock of aspiration history.2. Most common foreign bodies were bone fragments, and were mostly located in middle stem bronchial or in lower bronchial tree. Massive granulation tissue proliferation was most common in patients with aspiration of bone materials.3. Our experiences showed that flexible bronchoscopy was safely, simply and effectively used in the diagnosis and treatment of adult patients with foreign body aspiration4. Patient with a long medical history and a relative good general condition should be considered possibility of foreign body aspiration and experience bronchoscopy as early as possible while his imageology showed recurrent obstructive pneumonia.