Bronchoscopic removal of tracheobroncheal foreign bodies: value of patienthistory and timing

Between 1990 and 1999, 741 bronchoscopic procedures were performed in 698 c hildren, 594 of whom were evaluated for foreign-body aspiration (FBA) (mean age 3.9 years, male:female 287/307). Based on the presenting symptoms, cli nical outcome, and complications, two major groups were identified. Group 1 consisted of 438 patients with a definitive history of FBA. Most were admi tted soon after the aspiration with sudden onset of symptoms such as coughi ng, choking, wheezing, and respiratory distress. Group 2 comprised 156 pati ents with chronic pulmonary infections and/or atelectasis without a definit ive history of FBA. The most common radiographic finding was emphysema of o ne lung in group 1 (61.1%) and pneumonia in group 2 (70%). Among the patien ts in whom a FB was removed, the percentage of normal radiography was 17%. The FB was identified and removed in 83% of cases in group 1. The complicat ion rate in this group was 9.8%, and all the complications were treated med ically. Only 2 patients required intercostal drainage. In group 2, a FB was identified in 25% of bronchoscopic examinations and 17% of the patients de veloped complications. One of these patients underwent an urgent thoracotom y due to bilateral tension pneumothoraces and 2 required tracheostomies. Pa tients with a definitive history of FBA, even with a normal physical examin ation and radiographic findings, must undergo bronchoscopic investigation. Cases with late presentation and chronic pulmonary infection are at high ri sk. In this group care should be take in determining the indication and tim ing of bronchoscopy in order to prevent life-threatening complications.