Abstract
Background
Foreign body inhalation is a common and life-threatening emergency, and is most prevalent in young children. The traditional view is that tracheobronchial anatomy determines that an inhaled foreign body is more likely to enter the right main bronchus. This view has been challenged in young children, in whom the distribution of inhaled objects is more evenly distributed between the bronchi. We, therefore, investigated tracheobronchial anatomy relevant to foreign body inhalation in children.
Materials and methods
One hundred and fifty-six normal pediatric chest radiographs were selected from a large electronic database. Eight groups of radiographs were identified: supine (n=76) and erect; males (n=84) and females; aged <3 years (median age 12 [0.5–29] months) and ≥3 years (median age 126 [48–180] months). Tracheobronchial widths and angles were determined using a standardized technique with good reproducibility.
Results
Overall, children had a proximal right main bronchus that was consistently steeper and slightly wider than the left (P<0.001), becoming more vertical in the erect position (P=0.0001). In most children, the carina was positioned to the left of the mid-trachea, but in 34% of cases (40% of infants), it was to the right of the mid-trachea. The effects of age and gender were otherwise minimal.
Conclusion
On the basis of tracheobronchial anatomy, an inhaled foreign body is more likely to enter the right bronchial tree than the left in children of all ages. However, the variability in the position of the carina with respect to the mid-trachea may explain why this right-sided preference is less marked in children compared to adults.
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References
Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO (1999) Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 115:1357–1362
Brkić F, Umihanić S (2007) Tracheobronchial foreign bodies in children. Experience at ORL clinic Tuzla, 1954–2004. Int J Pediatr Otorhinolaryngol 71:909–915
Cataneo AJ, Reibscheid SM, Ruiz Júnior RL, Ferrari GF (1997) Foreign body in the tracheobronchial tree. Clin Pediatr (Phila) 36:701–705
Center for Disease Control and Prevention (CDC) (2002) Nonfatal choking-related episodes among children—United States, 2001. MMWR Morb Mortal Wkly Rep 51:945–958
Chen CH, Lai CL, Tsai TT, Lee YC, Perng RP (1997) Foreign body aspiration into the lower airway in Chinese adults. Chest 112:129–33
Cohen SR, Lewis GB Jr, Herbert WI, Geller KA (1980) Foreign bodies in the airway. Five-year retrospective study with special reference to management. Ann Otol Rhinol Laryngol 89:437–442
Cohen BS, Sussman RG, Lippmann M (1993) Factors affecting distribution of airflow in a human tracheobronchial cast. Respir Physiol 93:261–278
Cotton RT, Rutter MJ (2006) Foreign body aspiration. In: Chernick V, Boat TF, Wilmott RW, Bush A (eds) Kendig’s disorders of the respiratory tract in children, 7th edn. Elsevier Saunders, Philadelphia, pp 610–615
Daniilidis J, Symeonidis B, Triaridis K, Kouloulas A (1977) Foreign body in the airways: a review of 90 cases. Arch Otolaryngol 103:570–573
Divisi D, Di Tommaso S, Garramone M, Di Francescantonio W, Crisci RM, Costa AM, Gravina GL, Crisci R (2007) Foreign bodies aspirated in children: role of bronchoscopy. Thorac Cardiovasc Surg 55:249–252
Fewell J, Arrington R, Seibert J (1979) The effect of head position and angle of tracheal bifurcation on bronchus catheterization in the intubated neonate. Pediatrics 64:318–20
Landsman IS, Werkhaven JA, Motoyama EK (2006) Anesthesia for pediatric otorhinolaryngologic surgery. In: Motoyama EK, Davis PJ (eds) Smith’s anesthesia for infants and children, 7th edn. Mosby Elsevier, Philadelphia, p 816
Lowe D, Russell RI (1984) Tracheobronchial foreign bodies—the position of the carina. J Laryngol Otol 98:499–501
Moore KL, Dalley AF (2005) Clinically oriented anatomy, 5th edn. Lippincott, Williams & Wilkins, Philadelphia, p 126
Mu L, He P, Sun D (1991) Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope 101:657–660
Robinson MJ, Roberton DM (eds) (2003) Practical paediatrics, 5th edn. Churchill Livingstone, Edinburgh, pp 479 and 481
Standring S (ed) (2005) Gray’s anatomy: the anatomical basis of clinical practice, 39th edn. Elsevier/Churchill Livingstone, Philadelphia, pp 1075–1076
Tan HKK, Brown K, McGill T, Kenna MA, Lund DP, Healy GB (2000) Airway foreign bodies (FB): a 10-year review. Int J Pediatr Otorhinolaryngol 56:91–99
Tokar B, Ozkan R, Ilhan H (2004) Tracheobronchial foreign bodies in children: importance of accurate history and plain chest radiography in delayed presentation. Clin Radiol 59:609–615
Van Looij MAJ, Rood PPM, Hoeve LJ, Borgstein JA (2003) Aspirated foreign bodies in children: why are they more commonly found on the left? Clin Otolaryngol Allied Sci 28:364–367
Wiseman NE (1984) The diagnosis of foreign body aspiration in childhood. J Pediatr Surg 19:531–535
Zissin R, Shapiro-Feinberg M, Rozenman J, Apter S, Smorjik J, Hertz M (2001) CT findings of the chest in adults with aspirated foreign bodies. Eur Radiol 11:606–611
Acknowledgment
We wish to thank Dr. Baran Tokar of the Eskisehir Osmangazi University Faculty of Medicine, Turkey, for kindly providing the supplementary data from his publication cited in Table 4.
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Tahir, N., Ramsden, W.H. & Stringer, M.D. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr 168, 289–295 (2009). https://doi.org/10.1007/s00431-008-0751-9
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DOI: https://doi.org/10.1007/s00431-008-0751-9