Letter to the Editor
Bronchoaspiration of Foreign Bodies. Clinical Case and Review
Broncoaspiración de cuerpos extraños. Caso clínico y revisión
Antolina Gómez López
, Ricardo García Luján, Eduardo de Miguel Poch
Corresponding author
Unidad de Endoscopia Respiratoria, Hospital Universitario 12 de Octubre, Madrid, Spain
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Clinical Case and Review" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "358" "paginaFinal" => "359" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antolina Gómez López, Ricardo García Luján, Eduardo de Miguel Poch" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Antolina" "apellidos" => "Gómez López" "email" => array:1 [ 0 => "antolinagl@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "García Luján" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "de Miguel Poch" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Endoscopia Respiratoria, Hospital Universitario 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Broncoaspiración de cuerpos extraños. Caso clínico y revisión" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1377 "Ancho" => 1488 "Tamanyo" => 287930 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The upper images show the chest X-ray with the drill bit in the bronchus intermedius. In the lower figures, the chest CT can be seen on the left and the foreign body extracted is shown on the right.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At the end of the nineteenth century, foreign body (FB) aspiration had a mortality rate of 50%, but this has gradually fallen since the first endoscopic extraction performed by Gustav Killian. Modifications of the extraction technique followed, and today, flexible bronchoscopy is one of the most widely used methods in these cases. We present the case of a 67-year-old man diagnosed with aspiration of a dental drill bit used for dental implants.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient came to the Emergency Department from a dental appointment one hour earlier, during which a drill bit had accidentally fallen into his oral cavity while he was undergoing root canal treatment, and disappeared; the dentist believed that the patient had swallowed it, and referred him to our hospital. The patient was asymptomatic on arrival. Chest X-ray and computed axial tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed the drill bit in the bronchus intermedius, with no associated complications. Oral bronchoscopy was performed under sedation, and the bit was removed en bloc using crocodile forceps (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was discharged 24<span class="elsevierStyleHsp" style=""></span>h later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The first published case of endoscopic extraction occurred on 30th March 1897, when a 63-year-old German farmer experienced dyspnea, cough and hemoptysis after aspirating a pork bone (11<span class="elsevierStyleHsp" style=""></span>mm long and 3<span class="elsevierStyleHsp" style=""></span>mm wide). Using a modified Mikulicz-Rosenheim esophagoscope (a rigid tube illuminated with a head mirror) and rigid forceps, Gustav Killian managed to remove the splinter from the right main bronchus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">FB aspiration is most common in males aged between 1 and 2-years,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> with a mortality of 7% in children <4 years. The incidence in adults is <0.4%,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> mostly in the geriatric population, or in association with neurological diseases, alcohol or drug abuse, traumatic intubation, mental retardation, dental treatment and tracheotomy patients. The type of FB depends on the age: in children, up to 55% are of vegetable origin (peanuts and seeds<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>); in adults, Blanco et al. reported 32 cases of bronchoaspiration out of 9781 bronchoscopies performed, 78% of which were of inorganic material, followed by dental material.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Only one case involving the same dental object with characteristics and results similar to ours has been published.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Symptoms, when present, are usually: intractable cough, dyspnea or repeated infections. Abnormal findings on chest X-ray include atelectasia, infiltrates or signs of hyperinflation, although results are normal in more than 40% of patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bronchoscopy is the technique of choice; the most common location is the bronchus intermedius, and foreign bodies are observed in routine bronchoscopies in up to 9% of patients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The extraction technique varies from non-bronchoscopic techniques (in small, movable objects like dried fruits or seeds) where positioning maneuvers and/or the use of systemic steroids to reduce the edema and facilitate expectoration may suffice,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> to endoscopic techniques or thoracotomies. The endoscopic route will avoid distal displacement of the FB, using a Fogarty catheter or balloon prior to its extraction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Although flexible bronchoscopy is recommended in most cases,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> rigid bronchoscopy is the technique of choice in children <12 years and some adults, depending on the FB and patient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez López A, García Luján R, de Miguel Poch E. Broncoaspiración de cuerpos extraños. Caso clínico y revisión. Arch Bronconeumol. 2015;51:358–359.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1377 "Ancho" => 1488 "Tamanyo" => 287930 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The upper images show the chest X-ray with the drill bit in the bronchus intermedius. In the lower figures, the chest CT can be seen on the left and the foreign body extracted is shown on the right.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gustav Killian – a Milestone in the Otorhinolaryngology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Campos Meirelles" 1 => "R. Machado Neves-Pinto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Int Arch Otorrinolaringol" "fecha" => "2005" "volumen" => "9" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Airways foreign bodies: clinical presentation, diagnosis and treatment" ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "European respiratory monograph. Interventional pulmonology" "paginaInicial" => "136" "paginaFinal" => "148" "serieFecha" => "2010" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extraction of airway foreign bodies in adults: experience from 1987–2008" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Blanco" 1 => "A. Fernández-Villar" 2 => "J.E. Rivo" 3 => "V. Leiro" 4 => "E. García-Fontán" 5 => "M.I. Botana" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "ICVTS" "fecha" => "2009" "volumen" => "9" "paginaInicial" => "402" "paginaFinal" => "405" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual foreign body after dental filling" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Luezzi" 1 => "K. Kawamukai" 2 => "N. Lacava" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00408-013-9514-0" "Revista" => array:6 [ "tituloSerie" => "Lung" "fecha" => "2013" "volumen" => "191" "paginaInicial" => "677" "paginaFinal" => "678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24085321" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway foreign bodies: what's new" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.L. Swanson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2004-832713" "Revista" => array:6 [ "tituloSerie" => "Semin Respir Crit Care Med" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "405" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16088484" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000007/v1_201506250123/S1579212915001196/v1_201506250123/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000007/v1_201506250123/S1579212915001196/v1_201506250123/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001196?idApp=UINPBA00003Z" ]
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| 2018 April | 35 | 4 | 39 |
| 2018 March | 28 | 4 | 32 |
| 2018 February | 29 | 7 | 36 |
| 2018 January | 27 | 5 | 32 |
| 2017 December | 32 | 4 | 36 |
| 2017 November | 40 | 5 | 45 |
| 2017 October | 27 | 8 | 35 |
| 2017 September | 30 | 2 | 32 |
| 2017 August | 50 | 11 | 61 |
| 2017 July | 33 | 6 | 39 |
| 2017 June | 59 | 19 | 78 |
| 2017 May | 48 | 7 | 55 |
| 2017 April | 35 | 8 | 43 |
| 2017 March | 36 | 1 | 37 |
| 2017 February | 30 | 10 | 40 |
| 2017 January | 19 | 3 | 22 |
| 2016 December | 36 | 9 | 45 |
| 2016 November | 49 | 12 | 61 |
| 2016 October | 40 | 11 | 51 |
| 2016 September | 42 | 17 | 59 |
| 2016 August | 41 | 12 | 53 |
| 2016 July | 34 | 12 | 46 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 November | 1 | 3 | 4 |
| 2015 October | 40 | 3 | 43 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
Show all
