What are the common bronchial foreign bodies?
- Organic foreign bodies: These foreign bodies swell up and gradually increase the airway obstruction and irritation. Example peanuts, peas, apple, chickoo seeds and grains.
- Inorganic foreign bodies: Plastic beads, toys, buttons. These foreign bodies are often longstanding.
What are the clinical features in cases of bronchial foreign bodies?
- Early stage: Occurs immediately after the inhalation of the foreign body. There is intense coughing. If the foreign body is large it may cause cyanosis and even death. The foreign body may also be coughed out.
- Intermediate stage: The patient is relatively symptomless. The period of this stage depends on the size and type of foreign body.
- Late stage: The symptoms vary from bronchial obstruction, irritation and inflammation.
Obstruction: Three types of bronchial obstruction are seen:
- By-pass valve obstruction: The foreign body permits the by passage of air in and out on inspiration and expiration. No collapse or emphysema is seen.
- Check valve obstruction: Initially at expiration the bronchial wall contracts to bring the swollen mucosa in contact with foreign body. This valve like closure traps the air in the lungs causing emphysema with each respiratory cycle. Thus the valve permits entry of air beyond the foreign body on
- inspiration but not expiration.
- Stop valve mechanism: The foreign body gets embedded in the mucosa causing obstruction at all stages of respiration resulting in atelectasis.
Some of the foreign bodies may shift from right to left lung leading to alternating diminished air entry.
How are bronchial foreign bodies diagnosed?
Diagnosis: This is usually made on a detailed history.
Investigations:
- X-ray neck and chest: A radiopaque foreign body may be seen on plain X-ray.
- X-ray chest may show obstructive emphysema, tracheal shift, collapse and mediastinal shift
- CT Scan is extremely useful for locating a foreign body prior to bronchoscopy.
What is the treatment for bronchial foreign bodies?
- Bronchoscopy is performed for all suspected foreign bodies.
- Fluoroscopic bronchoscopy. This is done when a foreign body has invaded a part of tracheobronchial tree and cannot be safely removed.
