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PubMed1991

Ultrasound for the detection of foreign bodies.

STUDY OBJECTIVE: To determine the ability of an emergency physician to detect a variety of foreign bodies in an experimental model using a portable ultrasound device. DESIGN: Ten pieces of beef were sliced into cubes approximately 6 cm on each side. Six different groups of foreign bodies were examined: gravel, cactus spine, glass, metal, wood, and plastic. An independent observer placed the objects in a random fashion into the beef cubes. One hundred twenty observations were made using sets of ten beef cubes at a time. Five foreign bodies were placed into each set of ten beef cubes. INTERVENTIONS: A blinded emergency physician used a portable ultrasound with a 7.5-MHz transducer to determine the presence or absence of a foreign body in each cube. MEASUREMENTS AND MAIN RESULTS: Ultrasound detected 59 of 60 foreign bodies, including all cubes of meat embedded with gravel, cactus spine, plastic, metal, and wood. Glass was detected nine of ten times. Of the 60 cubes of meat with no foreign bodies, one false-positive was recorded. This yielded sensitivity, specificity, positive predictive value, and negative predictive value of 98%. Positive determinations by ultrasound were significantly greater in the meat cubes with foreign bodies compared with the control group with no foreign bodies (P less than .001 by chi 2). Although the subset of glass foreign bodies had one false-positive and one false-negative, it was not significantly different in comparison with the other groups (P greater than .05 by chi 2). CONCLUSION: Ultrasound has promise as a diagnostic tool for the detection of a variety of foreign bodies. Further clinical studies using ultrasound for the detection of foreign bodies are warranted.

Emergencies↗

PubMed1999

Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.

The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy.

Adolescent↗

PubMed1995

Bedside fluoroscopy for the detection of foreign bodies.

OBJECTIVE: To determine the sensitivity and specificity of portable fluoroscopy for foreign-body detection using an ex-vivo experimental model. METHODS: A prospective, randomized masked investigation was performed to characterize foreign-body detection in cubes of beef. Three emergency physicians (EPs) independently used a portable fluoroscope to determine the presence or absence of various foreign bodies in ten cubes of beef (approximately 6 cm on each side). Six different groups of foreign bodies were examined: glass, wood, graphite (pencil lead), metal (needle), plastic, and gravel. An independent observer placed the six objects randomly into each set of ten beef cubes. One hundred observations were made by each physician using sets of ten beef cubes at a time. RESULTS: Fluoroscopy detected 117 of 180 foreign bodies (sensitivity 65%; 95% CI 58-72%), including all cubes of beef embedded with gravel, metal, and glass. Graphite was detected 27 of 30 times (sensitivity 90%; 95% CI 74-98%). None of the plastic or wooden foreign bodies was identified despite magnification techniques and real-time imaging (sensitivity 0%; 95% CI0-12%, each). Of the 120 cubes of meat with no foreign body, two false-positives were recorded (specificity 98%; 95% CI 94-100%). The overall positive predictive value and negative predictive value of fluoroscopy were 98% and 65%, with 95% CIs of 94-100% and 58-72%, respectively. Interobserver agreement between the three EPs was considered excellent (kappa = 0.75). CONCLUSION: Bedside fluoroscopy lacks sufficient sensitivity to rule out many foreign bodies in the ED. Its use should be limited to suspected gravel, glass, pencil lead, and metallic objects, which are known to be radiopaque.

Emergency Medicine↗

PubMed2003

Risk factors predicting the development of complications after foreign body ingestion.

BACKGROUND: The aim of this study was to determine the predictive risk factors for complications resulting from foreign body ingestion. METHODS: A consecutive series of 1338 patients with suspected foreign body ingestion presenting from 1996 to 2000 were studied retrospectively. The potential risk factors for complications after foreign body ingestion were analysed by multivariate logistic regression and included concurrent medical illness, age, duration and types of symptoms, types of foreign body ingested, positive cervical radiographic findings and the level of foreign body impaction. RESULTS: Fish bone (62.7 per cent) was the commonest type of foreign body ingested. Most of the objects were impacted at or above the cricopharyngeus, the commonest site being the valleculae (31.4 per cent). Multivariate analysis showed that presentation delayed for more than 2 days (P < 0.001), positive cervical radiographic findings (P < 0.001) and foreign body impacted at the cricopharyngeus (P = 0.009) or upper oesophagus (P = 0.005) were significant independent risk factors associated with the development of complications after foreign body ingestion. CONCLUSION: In patients with a foreign body seen on plain cervical radiography, presentation delayed for more than 2 days after ingestion, and foreign body impacted at the level of the cricopharyngeus or oesophagus there is a high degree of correlation with the occurrence of complications. Awareness should be raised when these risk factors are present.

Adolescent↗

PubMed1994

Non-asphyxiating tracheobronchial foreign bodies in adults.

The presentations of 47 adult patients with a non-asphyxiating tracheobronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine ("acute group"); 1 month or more in 29 ("chronic group"), uncertain in four ("uncertain group"); and the foreign body was a broncholith in five patients ("broncholith group"). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient. Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients. The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to "suspicion of an endobronchial lesion" were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.

Acute Disease↗

PubMedDate not supplied

[Significance of topographic diagnosis of foreign bodies situated in the orbit].

Clinical picture of extraocular foreign bodies in the orbit is analyzed in 49 patients, specific features of the diagnosis and treatment of this condition are discussed. Study of the topography of foreign bodies in the orbit has helped distinguish the clinically significant area of fragment localization, areas at a high risk of developing complications, and 'quite' areas. A localizing probe on a space molding was found an effective diagnostic tool. Using this probe, stereotopic localization of a foreign body may be associated with roentgen-negative intraorbital structures, i.e. vessels, nerves, muscles. Topographic location of a foreign body helped explain a considerable vision acuity reduction in relatively transparent media, recurrences of hemorrhages to the fundus oculi, and the type of the pain syndrome. Foreign body removal is indicated in stubborn persistent pain and regressive time course of changes.

Diagnosis, Differential↗

PubMed1989

Clinical value of ultrasonography in the detection and removal of radiolucent foreign bodies.

A series of 39 consecutive patients with a suspected retained foreign body in the hand and in whom standard soft issue radiographs were negative were examined by real-time, high-resolution ultrasound scan. At operation 20 patients had radiolucent foreign bodies (18 wood, 2 thorns) removed. Ultrasound scan correctly localized 19 of the foreign bodies before surgery and failed to detect one. No foreign body was found in 19 patients. Ultrasound scan falsely predicted the presence of a foreign body in two of these cases. High-resolution ultrasound scanning is a sensitive, accurate technique for diagnosing foreign bodies which are otherwise difficult to demonstrate by conventional radiographic techniques, and provides accurate three-dimensional localization of the object which is of value to the surgeon at operation.

Adolescent↗

PubMed2002

Management of oesophageal foreign bodies in children.

OBJECTIVE: To evaluate the pattern and outcome of management of retained oesophageal foreign bodies in children. DESIGN: Retrospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, January 1991 to December 2000. SUBJECTS: One hundred and eight paediatric patients, aged 0-14 years managed for retained oesophageal foreign bodies. INTERVENTION: The foreign bodies were removed endoscopically, using either a larynoscope or a rigid oesophagoscope, under general anaesthesia. RESULTS: There were 108 patients, with a mean age of 3.0 +/- 0.8 years and age range of 23 days to 14 years. The male to female ratio was 1.5: 1. Sixty four (59.3%) patients were within 1-5 year age group. Coins constituted 79.6% of the retained foreign bodies. Over 90% of patients presented within the first four days of the incidence. The dominant complaints were drooling of saliva in 37 (40.2%) and difficulty in swallowing in 35 (38.1%) patients. The commonest sites of the foreign body retention were the upper third of oesophagus 52(48.2%) and the hypopharynx 36(33.3%). The main complications following the foreign body removal were oesophageal perforations 4(3.7%) and lacerations 16(15%). CONCLUSION: Retained oesophageal foreign body is a common childhood health hazard. Early diagnosis and prompt skillful removal are necessary for a satisfactory outcome.

Adolescent↗

PubMed1989

[Diagnosis of intraocular foreign body by computed tomography].

To evaluate the computed tomography in diagnosis of foreign bodies in the eye or close to the scleral wall, it was used with routine orbital radiography for comparison. The Simens Somatom DR3 CT Scanner with a 512 x 512 matrix was used in 50 random cases, and 45 cases were confirmed by surgery. The results indicated that the positive rate of CT in detecting intraocular foreign bodies was 98% (49/50), vs 90% (45/50) for radiography. The smallest metallic intraocular foreign body detected by CT was 0.4 x 0.25 mm and a cupric foreign body of 0.2 x 0.1 mm escaped detection. The error rate of CT in detecting single foreign body in the ocular wall was 1/30, while that of radiography was 10/30. Intraocular multiple foreign bodies could be demonstrated by multiple laminae of CT, and non-metallic foreign bodies could also be differentiated.

Adolescent↗

PubMed1981

Unsuspected esophageal foreign bodies in adults with upper airway obstruction.

Esophageal foreign bodies rarely cause respiratory distress in adults. While it is well known that upper airway obstruction can occur with esophageal foreign bodies in children, the otorlaryngologic literature mentions little of this problem in older patients. Two adults with airway obstruction from unsuspected esophageal foreign bodies are described, with emphasis on the problems of diagnosis and management. The possibility of an unsuspected esophageal foreign body should be kept in mind during the evaluation of respiratory distress in an adult, especially in one who is a poor historian or has a history of a psychiatric disorder. Early endoscopic removal in the treatment of choice, although esophagotomy may be required.

Adult↗

PubMed2002

Delayed diagnosis of a pediatric airway foreign body: case report and review of the literature.

Foreign body aspiration is a common pediatric problem that affects children of all ages, including those who are well into their adolescence. We describe the case of a 9-year old boy with an airway foreign body that had gone unrecognized for 3 months. We also review the literature on pediatric airway foreign bodies, with a focus on delayed diagnosis. A diagnosis of foreign body aspiration should be considered whenever a previously healthy child suddenly exhibits unexplained symptoms that are refractory to medical treatment and are consistent with airway obstruction.

Airway Obstruction↗

PubMed2002

Cutaneous foreign bodies: elusive presentation. Case report and review of the literature.

Injuries by foreign bodies are a common problem in children, and sewing needles are not uncommonly found foreign bodies. Cutaneous foreign bodies are also occasionally seen, and these patients are referred to dermatologists because of skin findings resulting from body reactions. In this report we present an unusual case of a foreign body presenting as a linear skin eruption.

Foreign-Body Reaction↗

PubMed1993

Endoscopic removal of foreign bodies in the mentally and physically handicapped.

Although foreign bodies of the gastrointestinal tract are common in children, they are rare in the adult. Complications of the foreign bodies are well recognized to be a cause of obstruction, bleeding and perforation of the intestine, or furthermore, they sometimes lead to death unfortunately. On the other hand, it is very difficult to diagnose and treat foreign bodies in the handicapped because of disability of complaining the symptoms. This paper reports a 31-year-old severe handicapped man suffering from foreign bodies in the esophagus and the small intestine, and was successful removed by endoscope.

Adult↗

PubMedDate not supplied

Ultrasound examination of foreign bodies. An in vitro investigation.

Ultrasound examination of foreign bodies most frequently encountered in the human body was performed when they were contained within a transmission medium acoustically resembling human soft tissues. All the foreign bodies evaluated (lead and plastic pellets, pieces of wire, nails, needles, small fragments of rock and glass, wooden slivers, surgical sponges and surgical threads) were detectable with ultrasound. Strong echoes were reflected from their surface when they were positioned favourably, although in some positions the echoes from a needle, fragment of glass, wooden silver, or surgical thread could not be distinguished from those of the surroundings. Acoustic shadows were also seen behind the foreign bodies. A striking column of reverberation echoes was demonstrated behind lead pellets and nails while behind a glass plate there was an acoustic shadow that was often difficult to detect because it was concealed by a mirror image. With modern grey-scale real-time equipment it is possible to demonstrate objects from various angles, a fact which should facilitate the detection of foreign bodies in vivo circumstances.

Foreign Bodies↗

PubMed2000

Airway foreign bodies (FB): a 10-year review.

A retrospective chart review of children who had airway foreign body removed via direct laryngoscopy and bronchoscopy (DLB) from 1987-1997 was conducted in Children's Hospital, Boston. Patient characteristics noted included age, sex, and clinical presentation. Pre-operative radiographic findings, reason for delay in evaluation, DLB findings, length of procedure, reason for repeat DLB, and types of foreign body etc. were recorded. Serious complications from aspirated foreign bodies such as severe airway obstruction and death tend to occur in infants and younger children because of their small airway size. A history compatible with foreign body aspiration dictates diagnostic endoscopy with or without radiologic confirmation. Chest and airway radiographs supplemented by fluoroscopy can increase the ratio of correct and early diagnosis. Fluoroscopy should be universally accepted as an initial diagnostic technique in airway foreign body evaluation. Fluoroscopy is not a worthwhile investigation if a preceeding chest radiograph suggests the presence of a foreign body. Long-standing airway foreign bodies are associated with considerable morbidity, and early diagnosis remains the key to successful and uncomplicated management of foreign body aspiration. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach.

Age Distribution↗

PubMed1991

Sonographic detection of foreign bodies of the extremities.

A prospective study to assess the accuracy of ultrasound in the detection and localization of foreign bodies of the extremities was undertaken. Forty-five patients with clinical suspicion of foreign bodies were included in the study. Among 20 patients with radio-opaque foreign bodies, ultrasonic detection of foreign bodies was achieved in 19 patients. In 25 patients, with no radiographic evidence of foreign body, ultrasonic detection of foreign bodies was made in seven patients and among these foreign bodies were confirmed and removed at surgery in five patients. Accurate pre-operative ultrasonic localization of foreign bodies was carried out in three patients.

Evaluation Studies as Topic↗

PubMed1999

[Present-day fiber endoscopy in the diagnosis and therapeutic tactics in foreign bodies of the upper digestive tract].

Characterization of foreign bodies and their localization in the digestive tract in 404 patients is given. Surgical methods of treatment of such patients are described. Endoscopy was used for examination and treatment. The adequate anesthesia is thought by the authors to be necessary for a successful endoscopic removal of the foreign bodies. The indications for general anesthesia are enumerated. The endoscopic removal of the foreign bodies during surgical interventions are indicated in patients with the perforation of the esophagus by a foreign body.

Adolescent↗

PubMed1986

Intravascular foreign bodies: percutaneous retrieval.

Percutaneous retrieval of an intravascular foreign body was performed in 20 patients. There were 14 through-the-needle intravenous catheter fragments. In four patients the embolized foreign body was a broken diagnostic catheter. One patient had a ventriculovenous broken catheter and another patient had a bullet in the pulmonary circulation. Eight foreign bodies were located in the superior vena cava, six in the pulmonary artery, two in the right side of the heart, one in the subclavian vein, one in the thoracic aorta, and two in the aortoiliac segment. Percutaneous retrieval was successful in 95% of the attempts. In one case the procedure was performed to dislodge the foreign body into a better position for surgical retrieval.

Adolescent↗