Management of Adults With Suspected Foreign Body Aspiration

Objective: Although foreign body aspiration (FBA) in adulthood is not as common as in childhood, it can sometimes be encountered with clinical situations that require urgent interventions. Removal of foreign bodies (FBs) is crucial in all cases of aspiration, even if they seem trivial and symptoms have resolved. Unremoved FBs cause chronic lung pathologies such as postobstructive pneumonia, bronchiectasis, atelectasis and scar formation which can be definitely treated only by FB removal. The treatment of choice is either fiberoptic or rigid bronchoscopy. The aim of our study was to create an algorithm for the management of patients presenting to our bronchology and interventional pulmonology unit with suspected FBA by reviewing their radiologic findings, the bronchoscopic methods used in their management and outcomes. Methods: We retrospectively reviewed the medical records of 70 patients who underwent fiberoptic bronchoscopy (FOB) and rigid bronchoscopy (RB) for suspected FBA in our bronchology and interventional pulmonology center between January 2010 and December 2019. Results: There were 70 patients with suspected FBA, who had an average age of 47.22±20.76 years, and 62.8% were males. Twenty-nine (41.4%) were treated with FOB and 25 (35.7%) with RB. A FB was detected initially by FOB in 16 (22.9%) who subsequently had to undergo RB for FB removal. Fifteen (33.3%) FOB and 9 (21.9%) RB procedures were performed on an emergent basis. A total of 86 bronchoscopic treatments were performed on 70 patients. FBs were detected with FOB in 29 patients. The FB was removed in 13 (28.8%) patients with the help of FOB, while 16 (35.5%) patients in whom FB removal was not possible were referred to the interventional pulmonology unit for RB. In the remaining 16 (35.5%) patients, no FB was found during FOB. A total of 41 patients were treated with RB, including 16 patients who had initially undergone FOB. FB was detected and removed in 38 (92.6%) patients, 2 (4.8%) patients had no FB detected and received no further treatment after being consulted with thoracic surgery. One (2.4%) patient in whom FB was detected but could not be removed was referred to surgery and was operated. Rates of FB detection were high for both chest x-ray and unenhanced thoracic computerized tomography (CT) in favor of CT (p=0.038 and 0.022 respectively). Thirty-three (58.9%) of the FB removed were in the right bronchial system and composition of FBs (organic or inorganic) was equal. Conclusion: When thoracic CT is not available chest x-ray can also be helpful in cases of suspected FBA. Because the possibility of FBA should be considered in many chronic pulmonary conditions, physicians choose FOB for their initial evaluation, especially if transfer to an interventional pulmonology unit is not feasible. RB performed by interventional pulmonologists is a safe therapeutic option in critical patients and cases when FOB fails.