Migration of FB in Bronchus in a young child.pptx

FB is moved from larynx to bronchus in a young girl

1. FB in Bronchus (Migrating) Ashok Aryal ENT & HNS

2. Case Report 3 Yr/F Presenting complain: difficulty in breathing, cough – 2 days H/o: No specific contributing factors, treated at local health center 1 day back No improvement- referred to higher center At ER: Diagnosed as Croup and admitted in paediatric ward Treated with Oxygen, Steroids Initially there was improvement for overnight but next morning worsened

3. History was taken thoroughly H/o ingestion of Dal, Bhat, Masu , after which she had cough FB in throat suspected X-ray neck done USG neck done

4. Foreign body in throat

5. Councelled the patient party Nasopharyngolaryngoscopy done under sedation FB visualized, oedematous epiglottis and VC Attempted to remove

6. Failure Tracheostomy done under LMA Counselled the patient party Admitted with ventilator and plan to refer higher center

7. Weaned off from ventilator on next morning Referred to Patan Hospital Again, did X ray neck at ER of Patan Hospital, FB in situ Shifted to OR Check X ray neck done, FB in situ

8. No FB visualized on rigid bronchoscopy With suspicion of dislodgement CT neck done FB identified in Left bronchus Flexible bronchoscope introduced through Tracheostomy tube, FB identified Removed with rigid bronchoscope

9. Decanulation and strapping done yesterday Admitted in high care due to prolong surgery, mucosal tears Patient improving

10. Issues????? Delayed in diagnosis due to Incomplete history

11. FB aspiration, epidemiology 350 to 2000 deaths in the United States annually male children of age <3 years are at high risk because of poor pharyngeal reflex , and a tendency to explore surroundings by mouth Nuts and seeds are commonly aspirated materials clinical manifestations are often nonspecific , which could lead to delay in diagnosis or in referral Dangol K. et al., 2021

12. Clinical Presentation Respiratory symptoms are helpful in the early diagnosis of laryngeal foreign bodies. Foreign bodies in the larynx usually cause dysphagia, dyspnea, cough, wheeze, stridor, or acute respiratory obstruction. Laryngeal foreign bodies may give rise to hoarseness which is unlikely with an object in the right main bronchus. However, some foreign bodies that do not cause obstruction can lead to indolent symptoms. If the correct diagnosis is not made at the initial evaluation , reflexes become relaxed, leading to less pronounced symptoms; this condition may be misdiagnosed as some other condition, such as asthma. Baidya et al., 2021

13. Baidya et al., 2021

14. Suspect Screen and X-ray every patient who is admitted with a history of having swallowed/ inhaled a foreign body or patient who suddenly develops cough and dyspnea. Radiological findings on chest films will often be normal (11-26%) unless there is a radiopaque foreign body present. Additional radiologic feature: hyperinflation, mediastinal shift, pneumonia, pneumothorax and atelectasis. The sensitivity and specificity of radiographs for airway foreign bodies have been calculated to be 73% and 45% respectively. Baidya et al., 2021

15. Baidya et al., 2021

16. Thank You