1. Чужди тела в бронхите
Основен курс Образна Диагностика
МУ-Варна
Д-р Радослав Георгиев

2. Епидемиология
•1500-3000сл с възможна причина за смърт в САЩ
•80% педиатрични случаи
•При възрастни- 80% заболявания на хранопровода
•При педиатричните само 10% имат патология на
хранопровода
•м/ж при децата=2/1
•При 1%- се налага операция

3. Ефекти
• Пълна обструкция на ГДП=смърт!
• Частична на ГДП:
• -хрипове
• -гръдна болка
• -при мукозна травма- кървене
• Обструкция на ДДП:
• -ателектаза
• -пневмония
• -редуцирано дишане

4. Най-чести тела, обект на аспирация
при децата
• Hot dog(най-честа фатална аспирация)
• Фъстъци(най-честа причина за ДДП
ателектаза)
• Монети
• Кости
• Балони
• Играчки
• Камъчета
• бутони

6. Foreign Body Aspiration
• Vegetable matter in 70-80%
– Peanuts & other nuts (35%)
– Carrot pieces, beans, sunflower & watermelon
seeds
• Metallic objects
• Plastic objects

7. • Organic f.b are more liable to evoke
larangospasm, tracheobronchitis and
lung infection. Hence, when patient
presents, often has fever.
• vegitable FB are slippery,hard to grip
and friable. They usually get swollen,
struk at subglottis, may lead to
complete obstruction.

8. Foreign Body Ingestions :
Most Common Types
ƒ Meat : most common in adults
ƒ Chicken bones : most common cause
of perforation
ƒ Sewing needles
ƒ Safety pins
ƒ Pills
–Doxycycline & AZT can cause esophageal
ulcers if impacted
ƒ Other objects listed on slide # 4

9. PATHOPHISIOLOGY
• Bronchi – 80-90%
– Right mainstem most common
• Carina
• Less divergent angle
• Greater diameter
• Trachea
• Larynx
• Larger objects, irregular edges
• Conforming objects

10. • Relevant Anatomy
• Airway foreign bodies can become
lodged in the larynx, trachea, and
bronchus. The size and shape of the
object determine the site of
obstruction.
• large, round, or expandable objects
produce complete obstruction, and
irregularly shaped objects allow air
passage around the object, resulting in
partial obstruction.

11. TYPES OF OBSTRUCTION.
• 1. check valve: air can be inhaled but not
exhaled.[emphysema].
2. ball valve: air can be exhaled but not
inhaled.[broncho pul segment collapse].
• 3. bypass valve: FB partially obstructs
both in insp. and exp.
4. stop valve: total obstruction, airway
collapse and consolidation.

12. • Presentation
• In general, aspiration of foreign bodies produces the
following 3 phases:
• Initial phase - Choking and gasping, coughing, or
airway obstruction at the time of aspiration
• Asymptomatic phase - Subsequent lodging of the
object with relaxation of reflexes that often results
in a reduction or cessation of symptoms, lasting
hours to weeks
• Complications phase - Foreign body producing
erosion or obstruction leading to pneumonia,
atelectasis, or abscess

13. X-RAY FINDINGS
• Obstructive emphysema
• Normal x-ray
• Pneumonitis
• Collapse with mediastinal shift
• Foreign body. If
still a diagnostic delima,CT scan is advised.

15. Foreign Body Aspiration

16. Foreign Body Aspiration

17. Symptoms of Foreign Body Aspiration into
the Tracheobronchial Tree
Respiratory arrest
Stridor
No symptons (up to 40 %)
Classic triad (in 40 %)
wheezing
coughing
dyspnea

18. Types of Bronchial Obstruction
Bypass valve obstruction
–air passes in and out
–no radiographic changes
–may cause no symptoms
Check valve obstruction
–exhalation around object prevented
–obstructive emphysema results
Stop valve obstruction
–both inspiration and expiration blocked
–distal atelectosis results
–pneumonitis may occur

19. Check valve obstruction
Stop valve obstruction

20. Chest X-ray for Aspirated Foreign
Bodies
ƒ Foreign object radiopaque in 6 to 20 %
ƒ CXR normal in 18 to 33 %
ƒ CXR findings:
–obstructive emphysema
–atelectasis
–pneumonia
ƒ Expiratory film enhances CXR yield

21. Inspiratory film on left, expiratory film on right ; Foreign body in left mainstem
bronchus

22. Inspiratory film on left, expiratory film on right ; Stop valve obstruction in left
mainstem bronchus

24. Left X-ray shows air trapping ; right X-ray (different patient) shows atelectasis

25. Inspiratory film on left ; expiratory film on right ; foreign body in right
bronchus

26. Other Studies to Consider to Demonstrate
Aspirated Foreign Bodies
ƒ Fluoroscopy : may enhance yield to 76 %
ƒ Xerotomography
ƒ Computed tomography
ƒ Contrast bronchography : usually not
useful

27. Management After Diagnosis of
Aspirated Foreign Body
ƒ Bronchoscopy : 99 % success rate
–rigid : often preferred in kids
–flexible
ƒ ventilation more difficult
ƒ can extract more distal objects
ƒ Patient should be observed 12 to 24 hours
post procedure (till CXR normal)

28. Differential Diagnosis of Partial Airway
Obstruction in Children
ƒ Foreign bodies
ƒ Iatrogenic
–laryngeal nerve paralysis
–tracheal ulceration or
granuloma
–vocal cord granuloma
ƒ Infections
–croup/epigloititis
–diphtheria
–retropharyngeal or
peritonsillar absess
ƒ Neoplasms
–hemangiomas
–angiofibromas
–teratomas
–lymphangiomas
–recurrent respiratory
papillomatosis
ƒ Other
–Lingual thyroid
–Congenital craniofacial
anomalies
–allergic edema

29. Fatal aspiration of an old Christmas bow button
Фатален случай на аспирация с коедна украса-пластмасов бутон за връх

30. Fatal laryngeal obstruction from a coin
Фатален слуачй на аспирация на монета и ларингеална обструкция

31. 1. Emergency Treatment for Aspirated
Foreign Bodies
ƒ -Heimlich maneuver
ƒ -Back blows
ƒ -Chest thrusts
–note : none of these should be applied if
patient is able to speak or cough
ƒ -Finger sweep / grasp
–should be done only if object is visible and will
not be wedged deeper

34. Chest thrusts for
pregnant victims

37. Foreign Body Aspiration
• General anesthesia
• Spontaneous ventilation
• Laryngoscopes
• Bronchoscopes
• Suction
• Forceps
• Rod-lens telescopes

38. Благодаря за вниманието !