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Letters to the Editor

Indian Pediatrics 1999; 36:209-210

Foreign Bodies in Respiratory Passages


I read with interest the recent report on this subject(1). Foreign body (FB) inhalation is a pediatric emergency. The pattent does immediately if the FB obliterates the respiratory passages completely. If the FB trickles down and settles in respiratory passages beyond the carina, the patient is likely to develop obstructive emphysema with wheeze, (ball valve obstruction), atelectasis (stop valve) or consolidation, which may progress to lung abscess or bronchiectasis. The advent of flexible fibreopticbronchoscope has revolutionised the diagnosis and management of FB. However, there are some interesting observations in the article and some doubts which need more clarification.

1. The reported series, highlighted that left sided FB can occur more commonly than right sided ones. What is even more interesting about the location, in this series is the presence of FB over the bifurcation of the trachea in 3 cases, resulting in obstructive emhysema in both the lungs. A FB which is inverted V shaped (e.g., open safety pin) or 'tent' shaped can sit over the carina with its apex pointing upwards. Even then it is difficult to comprehend how a FB with a wide base (wider than carina) can pass down the trachea. So I would like to know what type of carinal FBs were present in these 3 patients, their radiological appearances and their age. What was the prognosis in them. In two large series of 140 and 224 cases(2,3) the FBs were predominantly lodged on right side and not a single case of carinal FB was reported.

2. Bronchoscopic removal of FB was done in 20 cases, whereas 3 FBs were expelled spontaneously during investigations. What about the other 2 cases?

3. What could be the reason that not a single patient with radio opaque FB or with consolidation was documented in the series?

4. Lateralisation of FB depends on its. size and nature and on the age of the child. I would like an elaboration of this statement.
 

Ramesh Yelsangikar,
Goutam Nivas, Vitthal Nagar,
Gulbarga -
585 103,
India.

 

References


1
. Lakhani JK. Bronchial foreign body lateralisation in children. Indian Pediatr 1998; 35: 798-799.

2. Sharma AK, Agarwal LD, Prabhakar G, Gupta A, Sharma C, Chandra S. Therapeutic and diagnostic role of bronchoscopy in pediatric age group. Indian Pediatr 1992; 29: 287-290.

3. Mantel K, Butenandt I. Tracheobronchial foreign body aspiration in childhood. A report of 224 cases. Eur J Pediatr 1986; 145: 211-216.

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