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Objective/Hypothesis: Standard chest radiographs are a poor diagnostic tool for pediatric foreign body aspiration. Machine learning may improve upon the diagnostic capabilities of chest radiographs. The objective is to develop a machine learning algorithm that improves the diagnostic capabilities of chest radiographs in pediatric foreign body aspiration. Method: This retrospective, diagnostic study included a retrospective chart review of patients with a potential diagnosis of FBA from 2010 to 2020. Frontal view chest radiographs were extracted, processed, and uploaded to Google AutoML Vision. The developed algorithm was then evaluated against a pediatric radiologist. Results: The study selected 566 patients who were presented with a suspected diagnosis of foreign body aspiration. One thousand six hundred and eighty eight chest radiograph images were collected. The sensitivity and specificity of the radiologist interpretation were 50.6% (43.1–58.0) and 88.7% (85.3–91.5), respectively. The sensitivity and specificity of the algorithm were 66.7% (43.0–85.4) and 95.3% (90.6–98.1), respectively. The precision and recall of the algorithm were both 91.8% with an AuPRC of 98.3%. Conclusion: Chest radiograph analysis augmented with machine learning can diagnose foreign body aspiration in pediatric patients at a level similar to a read performed by a pediatric radiologist despite only using single‐view, fixed images. Overall, this study highlights the potential and capabilities of machine learning in diagnosing conditions with a wide range of clinical presentations. Level of Evidence: 3 Laryngoscope, 134:3807–3814, 2024 [ABSTRACT FROM AUTHOR]

Abstract The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P

The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P < 0.01). FBA most commonly occurs in January and February. More than 60% of FBAs occur between the ages of 1 and 2 years, and the incidence of FBA may be greater in children who are cared for by grandparents. A rigid bronchoscope can be used to remove most aspirated foreign bodies in a median of 16 min. [ABSTRACT FROM AUTHOR]

We present a case of dental prosthesis inhalation in CPAP treated patient with OSAS. This case, due to clinical characteristics, is comparable to a previously published case of inhalation of three teeth. Probably, in both cases, inhalation was favored by night ventilation in supine position. [ABSTRACT FROM AUTHOR]

ObjectiveForeign body aspiration events are frequent in young children and in the geriatric population. They may result in several complications such as hypoxia, edema, cardiac arrest, and death. Recently, two commercially available devices, the LifeVac and DeChoker, have entered the market with the claim of relieving foreign body aspiration. Both devices are portable, nonpowered, suction devices that are being considered for use in large public spaces such as schools, airports, and malls despite previous studies detailing variable efficacy. In this study, we aim to contribute further data on the safety and efficacy of these devices through a fresh cadaver model.MethodsCommonly aspirated foods of three different sizes (saltines, grapes, and cashews) were placed at the level of the true vocal folds in a fresh cadaver. Three participants performed two trials with each food and device. Device use was performed to manufacturer specifications.ResultsThe DeChoker resulted in gross injury to the tongue and failed to remove the obstruction in all trials. LifeVac was successful in removing the barium-moistened saltines but failed to remove all other foreign bodies. Both devices applied significant pressure to the tongue.ConclusionWith the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity in a clinical setting. We conclude bystanders should continue to follow International Liaison Committee on Resuscitation's guidelines on resuscitation to aid with relieving foreign body aspiration.Level of evidence4.

Background: Foreign body aspiration (FBA) is an important cause of morbidity and mortality in pediatrics. Flexible or rigid bronchoscopy is the gold standard for its diagnosis and treatment. However, despite being a minimally invasive test, it is not without risk and, given the low specificity of symptoms involved, between 45 and 70 % of diagnostic bronchoscopies (DB) performed are normal. The aim of this paper is to develop a strategy in order to reduce this percentage. Methods: Observational, analytical, and retrospective study of DB performed for suspected FBA between 2018 and 2022. Demographic, clinical, and radiological data, bronchoscopy findings and complications were obtained. Results: 96 patients admitted to DB were analyzed. 72 out of 96 (75 %) were normal. The risk of presenting a foreign body was significantly higher in patients with suspected nuts, so DB should be always indicated. In patients with suspected other materials aspiration, a multivariate analysis was performed using logistic regression. Statistically significant association was found between dyspnea, asymmetric auscultation and abnormal chest radiography with the presence of a foreign body on the DB; AUC = 0.97 (95 % CI 92.4 %-100 %). The proposed algorithm establishes patients at high risk of FBA and therefore the DB is recommended, with a sensitivity of 100 % and a specificity of 87.2 %. Conclusions: The application of the algorithm to patients with suspected aspiration of a foreign body other than nuts can facilitate the identification of patients with high risk of aspiration and reduce the percentage of negative DB.

Key message Foreign body aspiration is rare in adults but can be life‐threatening. This case highlights the subtlety of chronic foreign body aspiration presentation and the importance of judicious use of radiological tool and comprehensive history‐taking especially in patients with chronic cough.

Introduction: Foreign body aspiration (FBA) is a common, life-threatening pediatric emergency and was shown to be associated with high risk of morbidity and mortality. This systematic review and meta-analysis aimed to investigate the diagnostic value of chest computed tomography (CT) scan for identification of FBA in children. Methods: From inception to May 2024, a systematic search was carried out across multiple databases including Medline, Scopus, and Web of Science, considering published papers in English language. Quality assessment of the included studies was performed using seven domains of Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results: The systematic literature search yielded 7203 articles. The pooled sensitivity and specificity of chest CT scan for identification of FBA were 0.99 (95% CI: 0.98-0.99) and 0.97 (95% CI: 0.96-0.98), respectively. The pooled positive likelihood ratio was 10.12 (95% CI: 4.59-22.20), and pooled negative likelihood ratio was 0.05 (95% CI: 0.02-0.1). Furthermore, the area under the summarized receiver operating characteristic (SROC) curve was 0.98. Conclusion: Our meta-analysis revealed that despite high heterogeneity, in the diagnostic characteristics of chest CT scan among studies, it has high diagnostic value in identifying FBA in suspected pediatric cases.

Foreign body aspiration (FBA) is commonly seen in the age group of 1–3years, is a common cause of morbidity and mortality in children worldwide. They are less commonly seen below one year, hence challenging to manage. Aspiration of organic FB (Foreign body) causes severe airway mucosal inflammation. If not promptly removed, chronic inflammation sets in leading to the development of granulation tissue around it, ultimately presenting as a lung infection and collapse. Author is reporting here two rare cases of acute atelectasis in infants and their management.

The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department.

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided. [SJEMed 2024; 5(1.000): 058-060]

Foreign body aspiration occurs more frequently in young children due to immature anatomical and functional structures like underdeveloped mechanism of swallowing, weak airway protective reflexes or the absence of molars. We describe the case of a 13-months-old girl who presented for a subsided paroxysmal cough with a sudden onset and intermittent wheezing after eating a piece of walnut. We highlight the importance of a well conducted anamneses and an efficient communication in a multidisciplinary team by describing the way we diagnosed the patient, the therapeutic method used in the removal of the foreign body and the favorable evolution. We analyze the medical literature to check the similarities and differences observed in our case. This could raise awareness among pediatricians about this diagnosis and encourage general practitioners to get involved in educating the parents in Romania.

The study was carried out to determine the knowledge of child development students about foreign body aspiration in children, their first aid self-efficacy for foreign body aspiration, and to examine the relationship between their knowledge levels and first aid self-efficacy. The study was of descriptive and cross-sectional type. 118 students were included in the study. Descriptive Characteristics Form, Knowledge Evaluation Form about Foreign Body Aspiration in Children, and First Aid Self-Efficacy in Children with Foreign Body Aspiration Form were used to collect the study data. Foreign body aspiration knowledge scores of students were determined as 10.94 ± 2.29. The first aid self-efficacy score of students was low. A positive and significant relationship was found between students' knowledge scores and self-efficacy scores (p < 0.05). Although the level of knowledge of students about foreign body aspiration in children is above average, their first aid self-efficacy was found to be low. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS: This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS: Of the 255 patients with FBA, 17.6% (N 5 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Fortytwo percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS: The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue. [ABSTRACT FROM AUTHOR]

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal. [ABSTRACT FROM AUTHOR]

Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0–18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1–3; moderate, 4–6; high, 7–10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11–39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P <.001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78–4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016–2019 to 50% in 2020 (P =.042). Conclusion: FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. What is Known: • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. What is New: • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Foreign body aspiration (FBA) is a critical medical emergency, particularly in pediatric patients. Prompt recognition and intervention are essential to prevent complications and improve patient outcomes. Objective: This case series aimed to investigate the demographic characteristics, clinical presentation, diagnostic methods, management strategies, and outcomes of patients with FBA. Methods: Retrospective analysis of 50 cases of FBA. Data on demographic information, clinical presentation, diagnostic investigations, management approaches, and outcomes were collected from electronic medical records. Results: The study included 50 cases of FBA, with a predominance of pediatric patients. Common symptoms included coughing, choking, and wheezing. Diagnostic evaluation with chest X-rays and bronchoscopy confirmed FBA in all cases. Management strategies varied, with endoscopic retrieval being the preferred approach. Successful removal of the foreign body was achieved in the majority of cases, with minimal complications. Conclusion: This case series provides valuable insights into the epidemiology, clinical presentation, diagnostic methods, management strategies, and outcomes of patients with FBA. Early recognition and intervention are crucial to prevent complications and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Foreign body aspiration is an emergency event in children, with the most serious complications being pneumonia, atelectasis and choking. Prevention and management of choking through educating children’s mothers is the most important step in reducing its morbidity and mortality. Aim: The study was aimed to evaluate the effect of educational intervention on mothers' knowledge and practices regarding choking management from foreign body aspiration for their children. Subjects and method: A quasi- experimental research design was used in the present study. A convenient sample of sixty mothers with their children was collected from inpatient department and outpatient clinics of Ear, Nose and Throat of Tanta Main University Hospitals. Tools: Mothers’ knowledge regarding foreign body aspiration structured interview schedule and Observational checklist of pediatric foreign body airway obstruction management. Results: The overall mean scores of mothers' knowledge and practices were higher immediately after educational intervention implementation than before implementation, with significant statistically difference. Conclusion: There was a significant improvement in mothers’ knowledge and practices regarding choking management from foreign body aspiration after educational intervention implementation. Recommendations: Mothers continue to receive regular educational programs and practical trainings regarding choking first aid management to improve their knowledge and practices. [ABSTRACT FROM AUTHOR]

The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department. [ABSTRACT FROM AUTHOR]

Foreign body aspiration occurs more frequently in young children due to immature anatomical and functional structures like underdeveloped mechanism of swallowing, weak airway protective reflexes or the absence of molars. We describe the case of a 13-months-old girl who presented for a subsided paroxysmal cough with a sudden onset and intermittent wheezing after eating a piece of walnut. We highlight the importance of a well conducted anamneses and an efficient communication in a multidisciplinary team by describing the way we diagnosed the patient, the therapeutic method used in the removal of the foreign body and the favorable evolution. We analyze the medical literature to check the similarities and differences observed in our case. This could raise awareness among pediatricians about this diagnosis and encourage general practitioners to get involved in educating the parents in Romania. [ABSTRACT FROM AUTHOR]

Key message Cryoprobes represent an option for bronchial foreign body removal in cases of bronchial obstruction due to viscous substances such as mochi at body temperature.

Tracheal or bronchial foreign body aspiration is an important emergency o childhood requiring bronchoscopy under general anesthesia. In this retrospective study, bronchoscopy were performed for foreign body aspiration; anesthesia methods, risks, and postoperative complications were evaluated. Children who underwent bronchoscopy with suspicion of a foreign body in the pediatric surgery operating room between January 2010 and December 2021 were included in the study. Six hundred and sixty four children were evaluated. General anesthesia was applied to all bronchoscopy. Demographic characteristics of the patients, type of foreign body, localization of foreign body, distribution of foreign body according to age groups, complications related to anesthesia and surgical process, length of stay in the postoperative intensive care unit, and duration of hospital stay were evaluated. The patients who aspirated foreign bodies most frequently were children aged 1-3 years (73.6%). During bronchoscopy, organic matter (seeds, hazelnuts, peanuts, chickpeas) was the most frequently removed foreign body in children (559 patients). It was observed that foreign bodies were mostly located in the right main bronchus at a rate of 52.4%, the left main bronchus at 28%. The most common anesthesia-related complications were desaturation in 400 patients, hypercarbia in 200 patients, bronchospasm in 108 patients, and respiratory arrest in 2 patients. Many problems may be encountered in foreign body inhalation, and bronchoscopy of these patients should be performed by an experienced anesthesiologist and surgeon at the right time and in the safest way in terms of anesthesia and surgery.

Dirk Schürmann, Jacopo Saccomanno, Bettina Temmesfeld-Wollbrück, Martin Witzenrath, Ralf-Harto Hübner Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, 10117, GermanyCorrespondence: Dirk Schürmann, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany, Tel +49 30 450 653318 ; +49 1723871964, Email dirk.schuermann@charite.deAbstract: The risk of foreign body aspiration associated with uncapped handheld metered-dose inhalers (MDIs) is underestimated. We report a case in which a plastic cable clip accidentally lodged in the mouthpiece of an uncapped pressurized MDI was aspirated during its use. A literature search revealed 16 other cases of foreign body aspiration associated with uncapped handheld inhalers, all but one of which were pressurized inhalers. Patients should be informed of the risk of foreign body aspiration associated with uncapped pocket inhalers. The use of an uncuffed armoured tracheal tube with a separate oxygen tubing during flexible bronchoscopy for foreign body removal ensures a safe airway. Foreign bodies that exceed the lumen size of the tracheal tube can be pulled to the distal opening with forceps and removed when the tube is withdrawn.Plain Language Summary: Handheld pocket inhalers have significantly improved the treatment of patients with chronic obstructive pulmonary disease. We report a case in which a plastic cable clip accidentally lodged in the mouthpiece of an uncapped pressurized pocket inhaler was aspirated during its use. Depressing the plunger of the inhaler released the inhalant in a high-velocity spray, which was inhaled with a deep breath while simultaneously aspirating the plastic cable clip. The risk of foreign body aspiration associated with uncapped pressurized metered-dose inhalers is underestimated. Patients using pocket inhalers should be informed of the risk of foreign body aspiration with uncapped inhalers. Inhalers should always be kept capped except during use to prevent small objects from accidentally entering the mouthpiece. The cap of the inhaler mouthpiece should only be removed when the inhaler is used. Foreign bodies that have accidentally become lodged in the mouthpiece of an inhaler and aspirated into the lungs can usually be removed by specialists during a short outpatient procedure.Keywords: foreign body aspiration, metered-dose inhaler, removal of aspirated foreign bodies, uncuffed armoured tracheal tube with separate oxygen tubing

Abstract Objective Foreign body aspiration events are frequent in young children and in the geriatric population. They may result in several complications such as hypoxia, edema, cardiac arrest, and death. Recently, two commercially available devices, the LifeVac and DeChoker, have entered the market with the claim of relieving foreign body aspiration. Both devices are portable, nonpowered, suction devices that are being considered for use in large public spaces such as schools, airports, and malls despite previous studies detailing variable efficacy. In this study, we aim to contribute further data on the safety and efficacy of these devices through a fresh cadaver model. Methods Commonly aspirated foods of three different sizes (saltines, grapes, and cashews) were placed at the level of the true vocal folds in a fresh cadaver. Three participants performed two trials with each food and device. Device use was performed to manufacturer specifications. Results The DeChoker resulted in gross injury to the tongue and failed to remove the obstruction in all trials. LifeVac was successful in removing the barium‐moistened saltines but failed to remove all other foreign bodies. Both devices applied significant pressure to the tongue. Conclusion With the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity in a clinical setting. We conclude bystanders should continue to follow International Liaison Committee on Resuscitation's guidelines on resuscitation to aid with relieving foreign body aspiration. Level of Evidence 4

Over the course of the Coronavirus disease 2019 (COVID-19) pandemic, numerous complications have been documented. In this report, we have detailed an unexpected complication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that occurred in a 73-year-old female patient who was simultaneously afflicted with mucormycosis and another unanticipated problem. Due to the lack of recovery of the patient after receiving mucormycosis treatment and continued fever, cough and hemoptysis, bronchoscopy was performed for her. During bronchoscopy, we encountered a foreign body that was the cause of the patient’s fever, cough, and hemoptysis. Rigid bronchoscopy was performed and the foreign body was removed from the left main bronchus. The lack of a favorable treatment response after administering antifungal therapy suggested that the presence of a foreign body could potentially act as an underlying nidus, thus influencing the suboptimal therapeutic outcome. Mucormycosis is usually characterized by distinct radiological patterns. However, this case did not present predictable imaging findings, further complicating the diagnostic process associated with this invasive fungal infection.

Objective: Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication. Methods: Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges. Results: A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P <.001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P <.001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P <.001), and had a higher mortality rate (16% vs 0% vs 3.7%, P <.001). Conclusion: Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk. [ABSTRACT FROM AUTHOR]

Foreign Body Aspiration (FBA) is a common medical emergency among young children, but the evaluation and management of a suspected FBA case can vary across physicians and centers. We aimed to identify which clinical, laboratory, and radiological findings can predict FBA in children and to evaluate a clinical score to improve FBA prediction. This is a retrospective cohort study of patients aged 0–18 years admitted to Soroka University Medical Center between 2010 and 2020 with suspected FBA. All patients underwent flexible bronchoscopy and were divided into positive and negative FBA groups. A newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, was evaluated for its predictability. The study included 412 children (median age 21 months, 56.8% females), of whom 154 (37.4%) had FBA and 258 (62.6%) did not. Multivariate regression analysis showed exposure to nuts/seeds, unilateral wheezing or decreased breath sounds, stridor, and suggestive findings on chest X-ray were significant risk factors for FBA (OR [95%CI] -1.994[1.290–3.082], 1.487[1.206–1.832], 1.883 [1.011–3.509] and 2.386[1.917–2.970], respectively). However, a choking episode, acute cough, and absence of fever and rhinorrhea did not predict FBA. FOBAS showed an increased risk of FBA for each additional point of the score, with an odds ratio of 1.572 (95% CI—1.389–1.799). Conclusion: FOBAS is a good predictor for the presence of FBA in children. Once prospectively validated, FOBAS could aid in decision-making at the emergency department, enabling more standardized care, reducing unnecessary procedures, and leading to better clinical outcomes. What is Known: • The evaluation and management of a child with suspected foreign body aspiration (FBA) vary across physicians and centers, without a consensus regarding the indications and criteria for performing bronchoscopy. • Flexible bronchoscopy is the standard procedure for the diagnosis and sometimes treatment of FBA in children, but it may hold potential complications. What is New: • We propose a newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, for the prediction of FBA in children at the emergency department. • The FOBAS is a good predictor of FBA in children. The score enables more standardized care and may reduce unnecessary procedures. [ABSTRACT FROM AUTHOR]

Background This article evaluates the effect of coronavirus disease 2019 (COVID-19) pandemic on clinical course and management of cases that underwent bronchoscopy for suspected foreign body aspiration (FBA) in children. Methods The patients who underwent bronchoscopy with a presumptive diagnosis of FBA between July 2018 and December 2021 were evaluated for demographic features, clinical findings, management details, and outcomes. Patients were divided in two groups: before pandemic (group A) and during pandemic (group B). Results In total 79 cases with a median age of 5 years (4–5) in group A (n = 47) and 3 years (2–3) in group B (n = 32) were included (p < 0.05). The witnessed aspiration was significantly higher in group B (90.6%) when compared to group A (53%) (p < 0.05). Admission time was less than 48 hours in 30 cases (64%) in group A and 23 cases (72%) in group B (p = 0.002). The intervention time was less than 24 hours in 30 cases (64%) in group A, 9 cases (28%) in group B (p = 0.002). Bronchoscopy was performed after COVID-19 polymerase chain reaction (PCR) testing in all cases in group B. The positive FBA rate was 38% (n = 18) in group A, and 59% (n = 19) in group B (p = 0.067). Conclusion During pandemics, bronchoscopy for FBA was performed in younger infants than before pandemic and witnessed aspiration was significantly more common in that period. The differences in age groups and symptoms may be explained by spending more time at home during pandemics. Waiting for the PCR test results causes delays in the intervention. However, this delay did not cause any respiratory distress. [ABSTRACT FROM AUTHOR]

Tracheal or bronchial foreign body aspiration is an important emergency o childhood requiring bronchoscopy under general anesthesia. In this retrospective study, bronchoscopy were performed for foreign body aspiration; anesthesia methods, risks, and postoperative complications were evaluated. Children who underwent bronchoscopy with suspicion of a foreign body in the pediatric surgery operating room between January 2010 and December 2021 were included in the study. Six hundred and sixty four children were evaluated. General anesthesia was applied to all bronchoscopy. Demographic characteristics of the patients, type of foreign body, localization of foreign body, distribution of foreign body according to age groups, complications related to anesthesia and surgical process, length of stay in the postoperative intensive care unit, and duration of hospital stay were evaluated. The patients who aspirated foreign bodies most frequently were children aged 1-3 years (73.6%). During bronchoscopy, organic matter (seeds, hazelnuts, peanuts, chickpeas) was the most frequently removed foreign body in children (559 patients). It was observed that foreign bodies were mostly located in the right main bronchus at a rate of 52.4%, the left main bronchus at 28%. The most common anesthesia-related complications were desaturation in 400 patients, hypercarbia in 200 patients, bronchospasm in 108 patients, and respiratory arrest in 2 patients. Many problems may be encountered in foreign body inhalation, and bronchoscopy of these patients should be performed by an experienced anesthesiologist and surgeon at the right time and in the safest way in terms of anesthesia and surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the childhood-age foreign body aspiration (FBA) retrospectively by focusing on symptoms, types, home interventions, hospitalization and complications. All patients between 0–18 years admitted to pediatric surgical clinic and diagnosed with FBA were examined retrospectively from January 2021 to January 2022. The study group consisted of 163 patients and their mean age was 17.8±12.7 months (1 months to 6 years). FBA events included aspiration of food (78%), coins (10%), batteries (3.7%), parts of toys (4%), buttons (2.4%) and other (2%). First aid treatment to children was performed at home by mothers (61%). Types of first aid treatment performed by mothers included tapping the back (31%); cleaning inside the mouth (24%); trying to remove the foreign body with fingers (12%), pushing the foreign body forward (5.9%) and forcing the child to vomit (9.5%) respectively. FBA is a potential life-threatening health problem during childhood. When the age of majority of patients being under one year old and prevalence of food in FBA types are taken into consideration, safe-feeding practices of mothers, feeding position and training about the safe-environment are the basic steps of prevention strategies. One of the most useful ways of preventing FBA cases is to provide planned and continuing education to parents, care givers and all the individuals responsible for the care of the child in order to increase their knowledge and practice levels. • According to the results of the study, majority of FBA cases were younger than one year of age. • The most aspirated FBA types was food. • Pediatric nurses should include age-appropriate foods, safe eating habits, safe environment, routine child care education for parents, and provide parents with first aid skills. [ABSTRACT FROM AUTHOR]

Key message: Foreign body aspiration is rare in adults but can be life‐threatening. This case highlights the subtlety of chronic foreign body aspiration presentation and the importance of judicious use of radiological tool and comprehensive history‐taking especially in patients with chronic cough. [ABSTRACT FROM AUTHOR]

BackgroundTo evaluate the changes in the global burden of foreign body aspiration (FBA) among children under 5 years old at regional, age, sex, and socio-demographic index (SDI) levels between 1990 and 2019.MethodsData on FBA was derived from the Global Burden of Disease (GBD) Study 2019 database on pulmonary aspiration and foreign body in airway. The means and 95% uncertainty intervals (UIs) were calculated for incidence, and disability-adjusted life-years (DALYs). The temporal trends were represented by estimated annual percentage change (EAPC) using Joinpoint regression.ResultsGlobally, FBA caused 109.6 (95% UI: 69.5, 175.7) per 100,000 incidence and 317.9 (95% UI: 270.7, 372.4) per 100,000 DALYs under 5 years old in 2019. Many European countries (such as Italy, Netherlands, Iceland, etc.) showed a high incidence rate, but did not cause a large disease burden (DALYs all less than 200 per 100,000). Compared to 1990, although a decrease in both incidence and DALYs occurred in 2019, the Joinpoint regression showed an increasing trend in incidence rate from 2014 to 2019 [APC: both (2.10), female (2.25), male (1.98), P

Chest X-ray (CXR) is an important tool in the assessment of children with suspected foreign body aspiration (FBA), although it can falsely be interpreted as normal in one-third of the cases. The aim of this study is to evaluate the positive predictive value of CXR in children hospitalized with suspected FBA, when interpreted by three disciplines: pediatric pulmonology, pediatric radiology, and pediatric residents. This is a retrospective study that included children aged 0–18 years, admitted with suspected FBA, between 2009 and 2020 in one tertiary center. All patients underwent CXR and a flexible/rigid bronchoscopy for the definitive diagnosis of FBA, up to 1 week apart. Two physicians from each discipline interpreted the CXR, independently. Intra-raters' and inter-raters' agreements were assessed. Sensitivity, specificity, and area under the curve (AUC) were calculated for each discipline. Four hundred seventy-three children were included in the study, 175 (37%) with FBA and 298 (63%) without FBA on flexible/rigid bronchoscopy. The most common radiological findings, as interpreted by a pediatric pulmonologist, were unilateral hyperinflation (47%), radiopaque FB (37.6%), lobar atelectasis (10.3%), unilateral hyperinflation with atelectasis (3.4%), and lobar consolidation (1.7%). Intra-raters' agreement ranged from 0.744 (p < 0.001) among pediatric pulmonologists to 0.326 (p < 0.001) among pediatric radiologists. AUC for predicting FBA based on a CXR was 0.81, 0.77, and 0.7 when interpreted by pediatric pulmonologists, pediatric residents, and radiologists, respectively (p < 0.001). Conclusions: CXR has a high positive predictive value and independently predicts FBA in children; however, normal CXR should not rule out FBA. Predictability is variable among different disciplines. What is Known: • Chest X-ray is an important tool in the assessment of children with suspected foreign body aspiration (FBA). • Chest X-ray can be interpreted as normal in one-third of the cases. What is New: • Chest X-ray independently predicts FBA in children, with a high positive predictive value. • The ability of chest x-ray to predict FBA in children differs between pediatric residents, pediatric radiologists, and pediatric pulmonologists. [ABSTRACT FROM AUTHOR]

Background: One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death. Objectives: The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications. Methods: Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg < 20 kg, 5 mg > 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated. Results: There were 27 children in each group. There was no statistically significant difference between the two groups' time periods between the onset of the symptoms and procedure (P > 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups. Conclusions: The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion. [ABSTRACT FROM AUTHOR]

Foreign body aspiration represents one of the main causes of rising morbidity and mortality in children, mostly for the toddlers’ category of age. Both acute and silenced manifestation of this phenomena determines an immediate attitude in the management of the child in question. We present you a clinical case of a 2 years and 8 months old patient, diagnosed with sunflower seed coat aspiration, through flexible bronchoscopy. The implemented treatment consisted in rigid bronchoscopy and extraction of the foreign body.

Abstract Background Foreign body aspiration (FBA) is a serious condition with high morbidity and mortality rates. Although chest radiography is generally the first radiologic modality used in diagnosis, a substantial percentage of foreign bodies are radiolucent in adults with diagnosis challenging. Methods Retrospective review of adult patients with FBA diagnosed by flexible electronic bronchoscopy from 2012 to 2022 collecting demographics, history, hospital presentation, radiographic, and operative details. Risk factors associated with radiolucent foreign body inhalation in adults were explored using appropriate statistical methods. Results Between 1 January 2012 and 1 January 2022, 114 adult patients diagnosed with FBA were enrolled. The median age of participants was 65 years (IQR 52–74). Multidetector computed tomography (MDCT) examinations identified 28 cases (25%) showing direct visualization of the foreign body (defined as the radiopaque group) and 86 cases (75%) in the radiolucent group. Multivariable stepwise linear regression analysis showed increased odds of radiolucent foreign body inhalation in adults associated with pneumonic patches in MDCT (OR 6.99; 95% CI 1.80–27.22; P = 0.005) and plants/meat foreign bodies (OR 6.17; 95% CI 1.12–33.96; P = 0.04). A witnessed choking history (OR 0.02; 95% CI 0–0.14; P

Background: There is a high danger of foreign body aspiration (F.B.A.) since children put everything they find in their mouths. Children's tiny airways and undeveloped defensive mechanisms likely contribute to their higher rates of morbidity and deaths. Objective: Improving outcomes of patients with history of inhaled foreign body (F.B). Patients and Methods: We conducted a prospective cohort study on 90 cases suffered from foreign body inhalation (early or late management) in Cardio-thoracic Surgery Department, Zagazig University Hospitals. Results: We found 76.7 % of cases between age one and three years, 13.3 % of cases with age between three and ten years and 10% of the study sample had age more than ten years. 67.8% of the cases were males and 32.2% of them were females. As regard residence we reported that 65.6 % of cases were living in rural areas and 34.4% of them were living in urban areas. Conclusion: The timing of management of inhaled foreign bodies in children, whether early or late, can impact the clinical features and outcomes. Early management of inhaled foreign bodies tend to present acutely with choking and respiratory distress, while late management of inhaled foreign bodies may have more subtle and chronic respiratory symptoms. Prompt diagnosis and management are crucial in both cases to prevent complications and achieve favorable outcomes. [ABSTRACT FROM AUTHOR]

Approaching a child with dyspnea, coughing, and wheezing, doctors must consider a foreign body in the respiratory tract, and bronchoscopy should be performed. This report described a child having sunflower seed aspiration late‐ and misdiagnosed as pneumonia. He failed with antibiotics therapy. The patient underwent a bronchoscopy, and then the seed was found and entirely removed. [ABSTRACT FROM AUTHOR]

Necrotizing pneumonia (NP) is a rare but serious complication that occurs after foreign body retention. We report a case of severe NP in an infant caused by foreign body retention in the airway with no choking history. After a timely tracheoscopy and effective antibiotic treatment, her initial clinical symptoms were alleviated. However, she subsequently exhibited pulmonary manifestations of necrotizing pneumonia. To reduce the risk of NP from foreign body aspiration, for patients with airway obstruction and asymmetrical opacity of both lungs, timely diagnostic bronchoscopic evaluation is essential.

Foreign body aspiration is uncommon in adults who have no known risk factors such as mental retardation, poor dentition, or advanced age. Adults with foreign body aspiration are commonly misdiagnosed with bronchial asthma, however, does not respond to standard bronchodilator treatment. A thorough history-taking, focused physical examination and a high index of suspicion is crucial in making the correct diagnosis. This paper reports an interesting case of a 41-year-old woman with an undetected 10-year long foreign body aspiration which was misdiagnosed as bronchial asthma. [ABSTRACT FROM AUTHOR]

Abstract Approaching a child with dyspnea, coughing, and wheezing, doctors must consider a foreign body in the respiratory tract, and bronchoscopy should be performed. This report described a child having sunflower seed aspiration late‐ and misdiagnosed as pneumonia. He failed with antibiotics therapy. The patient underwent a bronchoscopy, and then the seed was found and entirely removed.

Foreign Body Aspiration (FBA) is a common medical emergency in children, demands a prompt diagnosis through clinical manifestations and radiological studies, to prevent complications and mortality. We present a case of a one-year-old female patient that accidently aspirated a foreign metal object into her airway. Two unsuccessful extractions through bronchoscopies were attempted, therefore a bronchotomy was carried out to remove the foreign object. The patient was uneventfully discharged after being monitored and receiving systemic antibiotics in the general hospitalization ward for seven days.

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses. [ABSTRACT FROM AUTHOR]

Immediate removal of foreign body (FB) can minimize the rate of complications. In the present study, we evaluated different types of foreign bodies, presenting clinical features amongst the children and their site of impaction. We also evaluated the anesthetic considerations during ventilation of pediatric airway in such Foreign body aspiration (FBA) patients. A retrospective study, for which prior Institutional Research Committee approval was taken, was conducted in 50 patients admitted in a tertiary care health centre. Relevant history regarding each patient's presenting symptoms or symptoms prior to hospitalization were recorded with special focus on interval between inhalation of foreign body and food intake. Each patient was examined for the nature and site of the foreign body. Appropriate method of ventilation for each case was discussed with the anesthesiologist before hand. Results of both therapeutic and diagnostic bronchoscopy were detailed. Majority of patients with foreign body aspiration (44%) were male children, between 1 and 3 years of age. The clinical features were mainly cough, respiratory distress and wheeze. Organic FB (73.9%) were the most common type of foreign body found. Right bronchus (64%) was the most common site of aspiration followed by left bronchus (24%). Jet ventilation was used in all the children, and duration of the rigid bronchoscopy was less than 15 min in majority of the cases. FBA are still dreaded as one of the leading causes of morbidity and mortality in infants and children that can be prevented by early diagnosis and management. [ABSTRACT FROM AUTHOR]

We describe an unusual presentation of a suspected pediatric foreign body (FB) aspiration which was found to be an occlusive inflammatory myofibroblastic tumor (IMT) of the distal trachea. These are rarely reported entities, with the potential for significant airway bleeds. Multidisciplinary discussion and involvement allowed for a safe patient outcome. [ABSTRACT FROM AUTHOR]

Lei Li,1,&ast; Meng-Jie Li,2,&ast; Liu Sun,3,&ast; Yuan-Liang Jiang,4 Jian Zhu5 1Department of the First Surgery, Wuhan Jin-Yin-Tan Hospital, Wuhan, 430011, People’s Republic of China; 2Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, 062650, People’s Republic of China; 3Department of Otolaryngology-Head and Neck Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China; 4Department of Radiology, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China; 5Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, 430070, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian Zhu; Yuan-Liang Jiang, General Hospital of Central Theater Command of the People’s Liberation Army, 627#, Wuluo Road, Wuchangqu, Wuhan, Hubei, 430070, People’s Republic of China, Tel +86-13871166489, Fax +86-27-50772388, Email zhujian0718@163.com; whzyyjyl@126.comAbstract: Foreign body aspiration (FBA) occurs less frequently in adults than in children. Case reports of FBAs occurring in adults after lung surgery are not found in the literature, and this particular condition is often misdiagnosed. We report a case in which the patient was diagnosed after various events. A 56-year-old female patient had undergone robotic-assisted resection of the right upper lobe. The patient recovered well after the operation, with a slight irritant dry cough. Chest computed tomography (CT) examination of the patient showed no obvious abnormality early postoperatively. However, she developed intermittent cough and hemoptysis at six months. Repeat chest CT showed a soft tissue shadow near the bronchus in the lower lobe of the right lung. Cancer recurrence, surgery-related foreign body residue, lymphoid reactive hyperplasia, or other reasons was considered. Further examination revealed a piece of watermelon seed shell blocking the bronchial opening of the lower lung. This case highlights the importance of medical history, careful physical examination and fiberoptic bronchoscopic examination after lung cancer surgery due to lung cancer recurrence risk or FBA.Keywords: foreign body aspiration, cancer recurrence, fiberoptic bronchoscopy, diagnosis