home
about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

Foreign bodies of the trachea and bronchi

Most often, foreign bodies of the respiratory tract are found in young children. This is because children, learning the world around them, take various objects into their mouths, and their protective reflexes are not sufficiently developed.

The frequency of predominant localization of foreign bodies in the respiratory tract is as follows: in the larynx - 13%, in the trachea - 22%, in the bronchi - 65% (Rokitsky M.R., 1978). Other authors cite approximately the same figures.

Facilitating moments for the penetration of foreign bodies into the respiratory tract are crying, laughing, talking with food, sudden excitement, accompanied by a deep breath while a food or foreign object (such as a pin or needle is a dangerous and common habit!) In the mouth, intoxication , as well as various neurological diseases (bulbar paralysis).

As soon as a foreign body passes the glottis, a reflex spasm occurs. The vocal folds close tightly, preventing the foreign body from being thrown back, despite a strong cough.

The overwhelming number of foreign bodies (70 - 30%), whose dimensions are less than the diameter of the trachea, fall on the right bronchus, which is almost a direct continuation of the larynx (Suprunov 3.K., 1960).

The clinical picture depends on the nature of the foreign body and the degree of its fixation in the lumen of the respiratory tract. Large foreign bodies (a piece of meat) caught during a conversation while eating in the respiratory tract can, first of all, obstruct the glottis of the larynx, or, passing through it, close the lumen of the bifurcation and cause asphyxiation, quickly lead to a tragic outcome.

Foreign bodies of plant origin (legumes, sunflower seeds), prone to swelling, can cause complete obstruction of the bronchus and atelectasis of the switched off segment of the lung, which leads to early infection and the development of pneumonia. Ears of cereals tend to penetrate into the pulmonary parenchyma, causing serious suppurative processes (Mitin Yu.V., 1994).

In the clinical course of the disease caused by a foreign body of the bronchus, three periods can be distinguished: the period of acute respiratory disorders, the secretive period and the period of complications.

The period of respiratory disorders begins from the moment a foreign body enters the respiratory tract and is accompanied by violent manifestations. It is characterized by paroxysmal, often repeated very painful cough for the victim, often turning into vomiting, which can simulate a clinic of a foreign body of the esophagus.

The secretive period begins with the field of movement of the foreign body through the respiratory tract with its subsequent fixation, expressed to one degree or another. Moreover, the farther from the main bronchi the foreign body is located, the less its clinical manifestations are expressed (Mitin Yu.V., 1994). This period is characterized by the disappearance of external manifestations of a foreign body. Breathing stabilizes, rare coughing fits can be regarded as symptoms of a cold.

The clinic of foreign bodies of the bronchi is determined by the general reactivity of the body, the length of stay of the foreign body in the bronchus and the variant of its obstruction. There are three types of bronchial obstruction: through, valve and complete.

In the first, most favorable form of obstruction, the foreign body does not completely close the lumen of the bronchus and does not cause a significant violation of gas exchange. The inflammatory process in the lung does not develop or is not clearly expressed.

The most common and unpleasant type of obstruction of the bronchus is valve. It occurs in cases where a foreign body almost corresponds to the diameter of the bronchus. During inspiration, with the expansion of the bronchus, air enters the lung. When you exhale, the lumen of the bronchus is reduced, which leads to its complete obstruction. As a result, distal to the foreign body, playing in this case the role of a valve valve, which lets in but does not let out air, there is an excessive accumulation of air and emphysema develops.

Complete obstruction of the bronchus turns off the blocked segment of the lung from the breath and leads to its atelectasis.

Atelectasis of the whole lung can occur reflexively, sometimes it is bilateral, which leads to very serious consequences.

A long stay of a foreign body causes the formation of bronchiectasis and suppurative process of the lung, which determines the further clinical picture of the period of complications.

The diagnosis of a foreign body of the trachea and bronchi is based on anamnestic data and clinical manifestations characteristic of a particular type of obstruction.

In typical cases, the diagnosis of a foreign body of the respiratory tract, especially the trachea, is not difficult. An important objective symptom is a cough, especially disturbing the patient at night. Sometimes coughing fits are accompanied by cyanosis and vomiting, resembling whooping cough. The appearance of a paroxysmal cough is characteristic with a change in body position, which is associated with the movement of a foreign object in the lumen of the respiratory tract and irritation of the mucous membrane. This movement of a foreign body and cough sometimes leads to its spontaneous removal.

A case is described when a patient with a foreign body of a bronchus making a trip to the hospital, shaking a railway carriage caused a cough, during which the foreign body on its own departed.

In our practice, we observed a patient with a hypersthenic physique with a short full neck, who, with a deep breath, got a cherry bone into the airways. During an additional x-ray examination, which was carried out after bronchoscopy, which did not bring success, she suddenly went away with a cough.
However, such happy examples of self-separation of a foreign body of the respiratory tract belong to casuistry.

An objective symptom of a foreign body of the trachea is its ballot, auscultation trapped like cotton. This is due to the impact of a foreign body thrown up during coughing on the lower surface of the vocal folds, which, in response to touching them, frantically contract, preventing it from exiting the trachea (Suprunov V.K., 1960).

With a complete obstruction of the bronchus over a portion of the lung turned off from the breath, weakened breathing and dullness of percussion sound are determined.

In the case of valve obstruction, the physical signs of emphysema are established. Incomplete obstruction of the bronchus does not give distinct percussion and auscultatory symptoms of a foreign body. Sometimes in these cases listening to stridor breathing is possible.

X-ray examination (fluoroscopy and radiography) is performed in all cases of suspicion of a foreign body.

It must be borne in mind that foreign bodies can be radiopaque in no more than 20% of cases (Mitin Yu.V., 1994). Without dwelling on all the details of the X-ray manifestation of the foreign body of the bronchi, its main signs should be noted, with which clinicians should be familiar. So, with incomplete through blockage of the bronchus, a pressure difference is created in both halves of the chest. As a result, when inhaling, the mediastinal organs - the heart and large vessels, move to the affected side, and when exhaling, they again occupy the middle position (Goltsknecht-Jacobson symptom). In the case of valve obstruction of the bronchus, the transparency of the affected segment of the lung increases, the mediastinal organs are shifted to the healthy side. Excursion of the diaphragm of the affected side is noticeably limited. With complete obstruction of the bronchus, as a result of the developed atelectasis, a homogeneous shadow radiologically determined, merging with the shadows of the mediastinum and the dome of the diaphragm.

The given clinical and radiological symptoms of foreign bodies of the trachea and bronchi, allows with a greater degree of probability to establish the correct diagnosis. In cases where the clinical manifestations are not clear enough and the diagnosis remains doubtful, the only reliable method is tracheobronchoscopy.

Thus, tracheobronchoscopy should be performed for diagnostic purposes in the presence of doubtful clinical signs of a foreign body and in all cases of its presence in the airways for removal.

Currently, foreign bodies of the trachea and bronchi are removed mainly through the natural pathways (upper tracheobronchoscopy) using a respiratory bronchoscope under general anesthesia and with the use of muscle relaxants. The widespread use in clinical practice of a respiratory bronchoscope, as well as fiber fiberscopes, allowed, in most cases, to abandon lower tracheobronchoscopy.

The following own clinical observation can serve as an illustration of the difficulty of establishing a diagnosis of a foreign body of the respiratory tract (bronchi) and the difficult circumstances that sometimes develop when it is removed.

A full man of 37 years during a business trip, eating a first course, accompanied by an active discussion of production matters, choked on meat bone. There was severe coughing and vomiting. In the future, there was a relative improvement, the patient was free to eat, voice and breathing were not disturbed. However, he was worried about recurring coughing fits and vague chest discomforts. Upon returning from a business trip, he was repeatedly examined in various medical institutions of the city, however, there was no suspicion of a foreign body of the respiratory tract and the absence of a foreign body of the esophagus was established. Clinical base of the Military Medical Academy. The doctor on duty, drawing attention to frequent coughing attacks, an anamnesis of the disease and suspecting a foreign body of the respiratory tract, hospitalized the patient. The characteristic appearance of coughing attacks during a change in body position (when getting out of bed) was noteworthy. There was no hemoptysis. Physical examination by the hospital’s therapists, given the patient’s completeness, did not establish sufficiently distinct clinical symptoms. When radiography was performed in the left half of the chest below the level of bifurcation a low-contrast shadow was determined, which could be mistaken for a foreign body. To clarify the diagnosis and remove a possible foreign body, the upper bronchoscopy using respiratory bronchoscope Friedel. A suspicious narrowing of the distal part of the left main bronchus filled with granulations was found. The foreign body was not visualized. Nevertheless, with forceps, it was possible to find a solid formation that wedged tightly into the wall of the bronchus. After repeated attempts, he managed to displace. It turned out to be a dense meat bone, resembling, in shape, a cocked hat with sharp edges. Removal of a foreign body that did not enter the lumen of the bronchoscope was performed simultaneously with its removal from the respiratory tract. When passing through the glottis, the bone caught on the vocal folds and slipped out of the forceps. Quickly inserted into the throat with the index finger managed to transfer the foreign body into the nasopharynx. After tracheal intubation and restoration of the normal course of anesthesia, in a calm environment, the foreign body was finally removed.
<< Previous Next >>
= Skip to textbook content =

Foreign bodies of the trachea and bronchi

  1. Injuries, foreign bodies of the esophagus, trachea and bronchus
    Injuries, foreign bodies of the esophagus, trachea and
  2. Foreign bodies
    Foreign bodies of the ear, nose, pharynx, and less commonly, the larynx, trachea, and bronchi, are more common. Foreign bodies of the ear are more common in children (paper, pencils, fruit bones), in adults - foreign bodies with sharp edges (fragments of matches) and insects. Rinsing with water is contraindicated during perforation of the tympanic membrane and complete obstruction of the lumen by a foreign body. Insects are killed before removal,
  3. Research methods of the trachea and bronchi
    The study of the lower respiratory tract, which include the trachea and bronchi, is carried out by endoscopic and radiological methods. With indirect laryngoscopy, you can see not only the sub-fold space of the larynx, but also the first rings of the trachea. With a deep breath, in individual patients it is possible to examine the trachea throughout the bifurcation area and even the beginning of the main bronchi. However,
  4. Physiology of the trachea and bronchi
    The main function of the trachea and bronchi is respiratory. During breathing, in connection with excursions of the chest, the trachea and bronchi make a number of movements, while the bifurcation of the trachea during inspiration moves down and anterior to 2 cm (Lepnev P.G., 1956). The volume of air in the tracheobronchial tree, the so-called "harmful space" is equal to 120 - 180 ml. Due to the presence, in the annular ligaments and
  5. Malformations of the wall of the trachea and bronchi.
    Malformations of the structural elements of the wall of the trachea, bronchi and bronchioles are morphologically associated with the absence, deficiency or disorganization of cartilage or elastic and muscle tissue. Malformations of the wall of the bronchi can be divided into limited and common. Limited defects of tracheobronchial structures usually lead to local narrowing of a particular segment
  6. Foreign bodies of the larynx
    Foreign bodies of the larynx, trachea and bronchi are more common in children. They enter the respiratory tract if the child inadvertently eats and adults do not control the behavior of children. Among foreign bodies, sunflower seeds, watermelon, pumpkin, pieces of carrots, coins, pins, parts of fountain pens, toys, etc. are more common. In adults, foreign bodies enter the respiratory tract with careless and inattentive
  7. Clinical anatomy of the trachea and bronchi
    The respiratory throat (trachea) is a continuation of the larynx, with which it is connected through the cricotracheal ligament (lig. Cricotracheale). Trachea - a long cylindrical tube (length 11-13 cm); it begins at the body level of Suz. and at the level of ThiV — Thv is divided into two main bronchi (bronchus principalis dexter et sinister). The beginning of the septum dividing the trachea is called the spur (carina;
  8. Damage to the bronchi and trachea
    Fractures of the first two ribs, sternum and collarbone are the most characteristic bone injuries that cause airway injuries. Hemoptysis, atelectasis, subcutaneous emphysema, pneumomediastinum or pneumothorax, which cannot be corrected by pleural drainage, are signs of possible damage to the main respiratory tract. (The presence of bilateral pneumothorax after blunt injury
  9. Clinical anatomy of the trachea and bronchi
    The respiratory throat or trachea is a direct continuation of the larynx and refers to the initial section of the lower respiratory tract. The trachea is a hollow elastic tube, somewhat compressed in the anteroposterior direction. Above, through the cricoid-tracheal ligament, it connects to the larynx, below, in the bifurcation area, it is divided into two main bronchi. Distinguish in the trachea
  10. Clinical physiology of the larynx, trachea and bronchi
    Resume function. The larynx is part of the airway; when inhaling, it conducts air to the lower sections - the trachea, bronchi and lungs, when exhaling, the air passes in the opposite direction. The act of breathing is provided by the respiratory muscles, and in the larynx by the contraction of the posterior cricoid muscles, which expand the glottis. When breathing, the glottis is always open,
  11. Foreign bodies of the respiratory tract
    Foreign bodies of the larynx and trachea are one of the most common causes of instant asphyxia in children. ETIOLOGY AND PATHOGENESIS The nature of foreign bodies is diverse: seeds, grains, berry seeds, meat and fish bones, small objects, in infants food masses with improper feeding. CLINICAL PICTURE The clinical picture depends on the location of the foreign body and the degree of obstruction of the respiratory
  12. ASPIRATION OF A FOREIGN BODY
    Definition Foreign body aspirated into the respiratory tract. Etiology Foreign body aspirated by a child. Entry into the trachea of ​​teeth displaced during manipulations in the upper respiratory tract. Surgical material remaining in the respiratory tract after surgery. Typical cases In children aged 7 months to 4 years: foreign body aspiration
  13. FOREIGN BODIES AND DAMAGE TO THE THROAT
    Foreign bodies fall into the throat when breathing or when swallowing and are countless diverse objects. The outcomes of a foreign body staying in the pharynx are different: it can be coughed up, expelled with exhalation, spit out, lie freely in the pharynx without injuring the mucous membrane, advance further and become a foreign body of the larynx, trachea and bronchi, the esophagus, and finally, injure the mucous membrane and
  14. Foreign bodies of the respiratory tract
    Aspiration of a foreign body into the airways can pose an extreme threat to the life of the child. Foreign bodies of the larynx and trachea are one of the most common causes of instant asphyxia in children. The vast majority of deaths from aspiration of a foreign body occur at the age of up to 5 years, and in more than half of cases, the age is less than one year. Clinical Diagnosis Symptoms
  15. Foreign bodies of the nose
    Clinical picture Foreign bodies of the nose are more common in children who, during the game, insert various small objects into their nose (beads, buttons, sunflower seeds, peas, berry seeds, coins, pieces of paper, etc.). Foreign bodies can get into the nose during combat and industrial injuries of the face (shell splinters, bullets, pieces of glass, stones, molten metal), as well as with vomiting
Medical portal "MedguideBook" © 2014-2019
info@medicine-guidebook.com