Cases reported "Pneumonia, Aspiration"

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1/35. Gastric aspiration and sleeping position in infancy and early childhood.

    Concern has been expressed that the recommendation of supine sleeping position for infants would result in an increase in deaths due to gastric aspiration. A review of 196 cases of infant and early childhood death in children under 3 years of age, occurring over a 9-year period (September 1989 to August 1998) was undertaken to ascertain how many cases of significant gastric aspiration had occurred. Extensive and widespread filling of the airways/alveoli with gastric contents was found in three infants/young children aged 5, 6 and 30 months, respectively. In each instance the body had been found lying face down (prone), with the face in a pool of vomitus in at least one case. No cases of significant gastric aspiration were found in infants who had been found lying on their sides or backs (supine). In addition, no significant increase in numbers of infant and early childhood deaths in south australia due to gastric aspiration over this time could be demonstrated. Concerns that the supine rather than the prone position is more likely to result in significant gastric aspiration are not supported by this study.
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2/35. Foreign body aspiration diagnosed by microscopy.

    We report a rare case of foreign body aspiration diagnosed by microscopic analysis of a sample of the foreign body. A 50-year-old man presented with a 5-month history of 40 pound weight loss and a nonresolving right lower lobe pneumonia. Medical history, radiographic studies, direct visualization of the foreign body by flexible fiberoptic bronchoscopy, and gross examination of a sample of the foreign body retrieved by a forceps biopsy catheter failed to yield the diagnosis. Moderate bleeding associated with the bronchoscopic "biopsy" procedure contributed to a preliminary misdiagnosis of endobronchial tumor. Microscopic analysis of the "biopsy" specimen demonstrated vegetable matter. The patient underwent rigid bronchoscopy and a peanut was retrieved from the bronchus intermedius. He was maintained on antibiotics for an additional 8 weeks and had complete clinical and radiographic recovery. The epidemiology, presentation, and management strategies of foreign body aspiration in the adult are briefly reviewed.
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3/35. sodium polystyrene sulfonate (kayexalate) aspiration: histologic appearance and infrared microspectrophotometric analysis of two cases.

    OBJECTIVE: sodium polystyrene sulfonate (kayexalate) is a cation-exchange resin given enterally for the treatment of hyperkalemia. Aspiration of this material is a rare occurrence, but when visualized in the alveolus, it has a characteristic microscopic appearance that is virtually diagnostic. In two cases, recognition of the characteristic morphology of the foreign material raised the question of sodium polystyrene sulfonate. DESIGN: We used infrared spectroscopy to demonstrate the presence of this material in lung biopsies of two patients by identifying foreign body particles. Histories of the patients were reviewed for exposure to sodium polystyrene sulfonate. SETTING: Two lung specimens were referred to the Armed Forces Institute of pathology with an unknown foreign material identified within the air spaces. patients: The lung biopsies were from two children, one postterm female infant who died at 3 days of life and a 4-year-old girl who underwent lung biopsy during surgical repair for tetralogy of fallot. Both patients had received sodium polystyrene sulfonate previously for control of hyperkalemia. RESULTS: The lung specimens showed characteristic basophilic, amorphous foreign material in airspaces on histologic sections. The identity of this material was confirmed by Fourier transform infrared microspectrophotometry. CONCLUSIONS: To our knowledge, we report the first two cases of sodium polystyrene sulfonate aspiration in children. This material has a distinctive morphologic appearance on histologic sections, and its identity can be confirmed by Fourier transform infrared microspectrophotometry.
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4/35. Rocuronium-induced generalized spontaneous movements cause pulmonary aspiration.

    Rapid-sequence induction with cricoid pressure is a standard procedure for inducing anesthesia in patients with a potentially full stomach. During the induction period, if the patient develops generalized movements of the body, the pressure level of the cricoid may change unexpectedly. As a result, the increase in intragastric pressure may cause gastric regurgitation and consequent pulmonary aspiration. Rocuronium has been widely used as an alternative to succinylcholine during the induction of anesthesia. However, most patients who received rocuronium complained of severe burning pain in their arm during intravenous injection. Even after the administration of the induction agents, rocuronium injection can also cause withdrawal of the hand or other generalized movements of the body. We describe a case of gastric regurgitation with pulmonary aspiration following generalized spontaneous movements associated with rocuronium injection in a girl who received pediatric emergent surgery.
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5/35. Aspiration of fruit gel snacks.

    Aspiration of a foreign body is common in children and can cause upper airway obstruction, leading to significant morbidity or mortality. We report 3 cases of aspiration of a popular fruit-flavored gel snack that led to cardiopulmonary arrest and death in 1 case and respiratory failure in 2 other cases. There is increasing concern about the safety of this gel snack and its risk of aspiration, even in older children. Pediatricians should advise parents and children about the dangers of eating this candy during their health maintenance visits.
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6/35. Near-fatal grape aspiration with complicating acute lung injury successfully treated with extracorporeal membrane oxygenation.

    OBJECTIVE: In this report of a near-fatal case of grape aspiration successfully treated with extracorporeal membrane oxygenation (ECMO), we highlight the danger of feeding seedless grapes to young children and demonstrate that ECMO can provide cardiopulmonary support for cases of acquired large-airway disruption and can facilitate therapeutic intervention. DESIGN: Case report. SETTING: A tertiary pediatric intensive care unit and ECMO center. PATIENT: A healthy 14-month-old boy aspirated a seedless grape while playing at home and suffered a cardiopulmonary arrest of 15 mins in duration. He responded to advanced life support with return of cardiac output but developed intractable cardiopulmonary failure secondary to aspirated grape particles and postobstructive pulmonary edema. INTERVENTIONS: The patient was emergently transferred to the regional ECMO center and placed on venoarterial ECMO. Bronchoscopies were performed in the stable environment provided by ECMO, aspirated particles were removed from the large airways, and lung recovery was facilitated. MEASUREMENTS AND MAIN RESULTS: End-organ perfusion was restored via ECMO during a period of severe intractable cardiopulmonary failure. Pulmonary recovery occurred during a 6-day ECMO run and was facilitated by therapeutic bronchoscopy. The patient was reviewed 1 yr later and has made a full neurodevelopmental recovery, despite a 15-min out-of-hospital cardiac arrest. CONCLUSIONS: Aspiration of a seedless grape is a life-threatening event in a small child. This danger is not fully appreciated by parents in the UK. ECMO may be life saving in cases of acquired large-airway disruption resulting in severe cardiopulmonary failure, including foreign body aspiration, as long as end-organ perfusion is maintained.
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7/35. Unsuspected foreign body aspiration.

    Aspiration of foreign bodies is a serious complication that may occur during the course of dental treatment. A case report of a 60-year-old man with recurrent pneumonia is presented. One year after the onset of his initial symptoms, a hard substance that made a complete mold of the bronchial tree at the inferior right lobe was extracted with a rigid bronchoscopy. This green material of elastic consistency was dental impression material (polyvinylsiloxane). On careful questioning, the patient indicated that he had dental impressions taken 2 months before the onset of the symptoms. Surgery was indicated and lobectomy of the inferior right lobe was performed without incident. To avoid this complication, some preventive precautions such as identifying high-risk patients; using rubber dam; tethering any small instrument with a ligature; placing a gauze screen to protect the oropharynx in sedated patients; and using custom impression trays to minimize the amount of impression material required have been suggested. In case of a suspected aspiration, the patient must be referred to appropriate medical care.
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8/35. Aspirated stoma button: an unusual complication.

    The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.
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9/35. granular cell tumor of the trachea in a child.

    Granular cell tumors are uncommon benign neoplasms. Their location is mostly in the head and neck region; appearance in other parts of the body is rare, but it has been reported. We present the case of a 14-year-old girl with a granular cell tumor of the trachea. The tumor was incidentally found at bronchoscopy performed to exclude suspected foreign body aspiration. It was located in the ventral part of the main carina. Biopsies revealed the histologic pattern of a benign granular cell tumor. The girl underwent resection of the main carina followed by reconstruction of a neo-carina with both main bronchi. She has not had any recurrence of the tumor during 3 years of follow-up.
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10/35. Massive aspiration of barium sulfate during an upper gastrointestinal examination in a child with dysphagia.

    barium sulfate is an agent used widely as a contrast material for imaging studies of the gastrointestinal tract and is not inherently toxic to lung tissue. Aspiration of barium sulfate has been reported on rare occasions, but is more frequently seen in patients with underlying anatomical or neurological defects such as head and neck deformity, esophageal stricture, diverticulum or fistula. We report a previously healthy child suffered from massive aspiration of barium sulfate during the investigation of dysphagia due to an impacted foreign body in the esophagus. Massive aspiration of barium sulfate is potentially life-threatening because of mechanical interference with gas exchange. An obstruction of the esophagus should be considered in the differential diagnosis for children with acute dysphagia and barium contrast should be used with great care in such instance.
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