Respircase Cilt: 9 - Sayı: 3 Yıl: 2020

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Approach to Foreign Body Aspiration in an Infant Using a Cryoprobe | Moslehi et al.Figure 2: Left main bronchus fully obliterated by the FB embedded in thegranulation tissue (A), Using the cryoprobe with repeated freezingthawingcycles pointing at the head of the object (B), Left Lower lobeafter the FB removal (C), FB (nut particle) (D)Figure 3: Chest X-ray obtained after the procedure showing a fullyexpanded left side lungThe slight bleeding that occurred was easily managedthrough the installation of diluted adrenalin (1:10000).Nebulization (Salbutamol 1.5 mg, and adrenalin 1:1000two ml diluted in 2 ml normal saline) and steroids (IVDexamethasone 1.5 mg every 8 hourly) were appliedpostoperatively. The post-operative period was uneventful.A chest X-ray obtained after the procedure showed a fullynormal expanded lung on the left side (Figure 3).DISCUSSIONRetained FBs, especially in the pediatric age group, canbe one of the most challenging problems for interventionalbronchoscopists, and may result in such seriouscomplications as pneumonia, atelectasis or bronchiectasis(2). The risk associated with these long-term complicationsis increased as the time from aspiration to diagnosisincreases. Remained FBs can be classified into twogroups: primary (due to late diagnosis or Silence FB aspirationsyndrome) and secondary (due to unsuccessfulbronchoscopy) (1). RB is the optimum treatment approachto the management of FBs in all ages, however the retrievalof FBs through the use of an RB can be hamperedby several factors, including the type and diameter of theFB, the time elapsed since diagnosis, the place in whichthe FB is lodged and the extent to which it is embeddedby granulation tissue. The age of the child is also veryimportant, as in younger children, the diameter of theairway may be too small to pass an RB and accessories(such as forceps, baskets), which increases the chance ofunsuccessful attempts at removal. Recently the use offiberoptic bronchoscopes for the retrieval of pediatricairway FBs has increased. The smaller size and betternavigational properties of flexible bronchoscopes permitthe examination of the lower airways with fewer traumas,which is not possible with a rigid bronchoscope (3). Therehave been many studies reporting on the successful useof various instruments, such as forceps or baskets, for theextraction of foreign bodies in the airway (4,5). Althoughthere have been studies into the cryoextraction of FBs,there have been few case reports and studies examiningthe safety and efficacy of this method in young infants. Inthe most recent study conducted in pediatrics, the studiedcases were older than 10 months and their weight weremore than 10 kg. Zhang et al. concluded that removal offoreign bodies from the airways of children using flexiblebronchoscopy CO2 cryotherapy may be considered asafe, easy and effective method (6). To the best of theauthor’s knowledge, the index case is unique, in that theage and weight of the patient were lower than the casespublished in the literature to date. The FB was lodgeddistally in the left lower lobe bronchus, and more interesting,the extraction with the RB wasn’t successful.CONCLUSIONSFor the bronchoscopic removal of an FB, RB is still theapproach favored by most clinicians, although a varietyof flexible techniques and tools are available. The indexcase highlights the successful use of a CO2 cryoprobe forthe extraction of a small FB lodged distally in the leftlower lobe bronchus that was fully embedded by granulationtissue during a flexible bronchoscopy.CONFLICTS OF INTERESTNone declared.6 www.respircase.com
Respiratory Case ReportsAUTHOR CONTRIBUTIONSConcept – M.A.M.; Planning and Design - M.A.M.; Supervision- M.A.M.; Funding - M.A.M.; Materials -M.A.M.; Data Collection and/or Processing - M.A.M.;Analysis and/or Interpretation - M.A.M.; Literature Review- M.A.M.; Writing - M.A.M. Critical Review - M.A.M.YAZAR KATKILARIFikir - M.A.M.; Tasarım ve Dizayn - M.A.M.; Denetleme -M.A.M.; Kaynaklar - M.A.M.; Malzemeler - M.A.M.; VeriToplama ve/veya İşleme - M.A.M.; Analiz ve/veya Yorum- M.A.M.; Literatür Taraması - M.A.M.; Yazıyı Yazan -M.A.M.; Eleştirel İnceleme - M.A.M.REFERENCES1. Moslehi MA. Silence foreign body aspiration syndrome. JPediatr Neonatal Care 2015; 2(5):00088. [CrossRef]2. Karakoç F, Karadağ B, Akbenlioğlu C, Ersu R, Yildizeli B,Yüksel M, et al. Foreign body aspiration: what is the outcome?Pediatr Pulmonol 2002; 34:30-6. [CrossRef]3. Kazachkov M, Vicencio A. Foreign body removal is getting"cooler" Pediatr Pulmonol 2016; 51:886-8.[CrossRef]4. Rodrigues AJ, Scussiatto EA, Jacomelli M, ScordamaglioPR, Gregório MG, Palomino AL, et al. Bronchoscopictechniques for removal of foreign bodies in children'sairways. Pediatr Pulmonol 2012; 47:59-62. [CrossRef]5. Tenenbaum T, Kähler G, Janke C, Schroten H, DemirakcaS. Management of foreign body removal in childrenby flexible bronchoscopy. J Bronchology Interv Pulmonol2017; 24:21-8. [CrossRef]6. Zhang L, Yin Y, Zhang J, Zhang H. Removal of foreignbodies in children's airways using flexible bronchoscopicCO2 cryotherapy. Pediatr Pulmonol 2016; 51:943-9.[CrossRef]Cilt - Vol. 9 Sayı - No. 1 7
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Respircase Cilt: 9 - Sayı: 3 Yıl: 2020

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