A study of clinical presentations and complications of foreign body in the bronchus - own experience.

Objectives: In this study, we studied varied clinical presentations and complications of a foreign body in the airway and complications of bronchoscopy, if carried out.

Methods: A prospective observational clinical study in a tertiary care centre from June 2010 to May 2012 included 46 paediatric patients aged less than 12 years, with suspected foreign body aspiration, all of whom underwent rigid bronchoscopy under general anaesthesia. All the patients were subjected to history taking, clinical examination, and investigations (pre- and post-op chest X-ray and CT virtual bronchoscopy, if required).

Results: The most common age of presentation was 1 to 3 years, within 48 hours from aspiration. A total of 87% of patients had a definite history of aspiration, with cough (69.5%), and unilateral decreased air entry (91.3%) being the most common symptom and clinical sign, respectively. Emphysema was the most frequent finding on chest X-ray (71.7%), and the sensitivity of CT virtual bronchoscopy was 80%. Majority of the foreign bodies were organic (84.7% - especially peanuts) and mostly found in the right bronchus (47.8%). Post-op complications were rare (pneumothorax, pneumonic patch), and were managed conservatively. None of the patients required a tracheostomy and there was zero mortality.

Conclusions: A positive history is by itself an indication for bronchoscopy. Clinical signs and X-ray changes should guide the clinicians towards the possible location of the foreign body. CT virtual bronchoscopy can be carried out in suspected cases with no specific history or clinical signs. Bronchoscopy can be conducted with minimal complications when performed by co-ordination of an expert surgeon and an anaesthetist.