Corpo estranho em árvore traqueobrônquica: Análise clínica e radiológica de todos os casos em quarenta e cinco anos de história.
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Data
2022-09-01
Autores
Furlan, Isadora Rubira
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÃO: A aspiração de corpo estranho (CE) é um problema de saúde que acomete todo o mundo. Agudamente leva ao risco de asfixia, e cronicamente pode levar a lesões irreversíveis nos pulmões. OBJETIVOS: Analisar os casos de aspiração de CE nos últimos 45 anos, atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - HCFMB, demonstrando sua apresentação clínica, características radiológicas, método de extração, complicações e necessidade de intervenção cirúrgica. MÉTODOS: Trata-se de um estudo observacional, retrospectivo e documental de pacientes diagnosticados com aspiração de corpo estranho através da análise de fichas catalogadas em arquivo do acervo da disciplina de Cirurgia Torácica do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no período de 1976 a 2021. RESULTADOS: Foram atendidos no serviço de cirurgia torácica 227 pacientes suspeitos ou vítima de aspiração de corpo estranho, sendo todos catalogados no acervo da disciplina de Cirurgia Torácica da Faculdade de Medicina de Botucatu – UNESP. A mediana da idade foi de 3 anos, com primeiro quartil de 1 ano e terceiro quartil de 10 anos. A história foi compatível com aspiração de CE em 82% dos casos e 18% não apresentavam história que pudesse levar a suspeita. Noventa e dois por cento foram submetidos à broncoscopia rígida, 3,5% submetidos a broncoscopia flexível, 1,3% a laringoscopias diretas e 3,2% eliminaram o CE expontaneamente. A sensibilidade dos achados clínicos foi de 97%, especificidade de 5%, com acurácia de 79%. Dos achados radiológicos, sensibilidade 99%, especificidade de 17,5%, acurácia de 84,5%. Dez paciente necessitaram de cirurgia (4,4%) e 79 desenvolveram complicações (34,8%). CONCLUSÃO: Toda suspeita de CE deve ser investigada mesmo com exame negativo. Muitos CE permanecem na arvore brônquica o tempo suficiente para que ocorram complicações graves, podendo culminar com destruição pulmonar. A maioria dos CE são radiotransparentes e constituídos na sua maior parte por grãos ou sementes. A maioria dos CE são retirados por endoscopia. Poucos são os casos que necessitam de cirurgia devido a complicações pela permanência prolongada do CE ou pela dificuldade na sua retirada. A retirada do CE deve ser indicada o mais cedo possível para evitar as complicações.
INTRODUCTION: Foreign body (FB) aspiration is a common health problem worldwide. Acutely it leads to the risk of suffocation, and chronically it can lead to irreversible lung damage. OBJECTIVES: To analyze the cases of FB aspiration in the last 45 years, treated at Hospital das Clínicas, Faculty of Medicine of Botucatu – FMB, demonstrating their clinical presentation, radiological characteristics, extraction method, complications and need for surgical intervention. METHODS: This is an observational, retrospective and documentary study of patients diagnosed with foreign body aspiration through the analysis of files cataloged in the archive of the Thoracic Surgery discipline collection at Hospital das Clínicas, Faculty of Medicine of Botucatu – FMB, from 1976 to 2021. RESULTS: A total of 227 patients suspected of or victims of aspiration of a foreign body were treated at the thoracic surgery service, all of which were cataloged in the collection of the Thoracic Surgery discipline of the Faculty of Medicine of Botucatu – UNESP. The median age was 3 years, with a first quartile of 1 year and a third quartile of 10 years. The history was compatible with aspiration of FB in 82% of the cases and 18% had no history that could lead to suspicion. Ninety-two percent underwent rigid bronchoscopy, 3.5% underwent flexible bronchoscopy, 1.3% underwent direct laryngoscopies, and 3.2% spontaneously eliminated the FB. The sensitivity of the clinical findings was 97%, specificity of 5%, with an accuracy of 79%. Of the radiological findings, sensitivity 99%, specificity 17.5%, accuracy 84.5%. Ten patients required surgery (4.4%) and 79 developed complications (34.8%). CONCLUSION: Any suspicion of FB should be investigated even with a negative test. Many FBs remain in the bronchial tree long enough for serious complications to occur, which can lead to lung destruction. Most EC are radiolucent and consist mostly of grains or seeds. Most FBs are removed by endoscopy. Few are the cases that require surgery due to complications caused by the prolonged permanence of the FB or the difficulty in removing it. Removal of the FB should be indicated as early as possible to avoid complications.
INTRODUCTION: Foreign body (FB) aspiration is a common health problem worldwide. Acutely it leads to the risk of suffocation, and chronically it can lead to irreversible lung damage. OBJECTIVES: To analyze the cases of FB aspiration in the last 45 years, treated at Hospital das Clínicas, Faculty of Medicine of Botucatu – FMB, demonstrating their clinical presentation, radiological characteristics, extraction method, complications and need for surgical intervention. METHODS: This is an observational, retrospective and documentary study of patients diagnosed with foreign body aspiration through the analysis of files cataloged in the archive of the Thoracic Surgery discipline collection at Hospital das Clínicas, Faculty of Medicine of Botucatu – FMB, from 1976 to 2021. RESULTS: A total of 227 patients suspected of or victims of aspiration of a foreign body were treated at the thoracic surgery service, all of which were cataloged in the collection of the Thoracic Surgery discipline of the Faculty of Medicine of Botucatu – UNESP. The median age was 3 years, with a first quartile of 1 year and a third quartile of 10 years. The history was compatible with aspiration of FB in 82% of the cases and 18% had no history that could lead to suspicion. Ninety-two percent underwent rigid bronchoscopy, 3.5% underwent flexible bronchoscopy, 1.3% underwent direct laryngoscopies, and 3.2% spontaneously eliminated the FB. The sensitivity of the clinical findings was 97%, specificity of 5%, with an accuracy of 79%. Of the radiological findings, sensitivity 99%, specificity 17.5%, accuracy 84.5%. Ten patients required surgery (4.4%) and 79 developed complications (34.8%). CONCLUSION: Any suspicion of FB should be investigated even with a negative test. Many FBs remain in the bronchial tree long enough for serious complications to occur, which can lead to lung destruction. Most EC are radiolucent and consist mostly of grains or seeds. Most FBs are removed by endoscopy. Few are the cases that require surgery due to complications caused by the prolonged permanence of the FB or the difficulty in removing it. Removal of the FB should be indicated as early as possible to avoid complications.
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Corpo estranho, Broncoscopia, Árvore traqueobrônquica, Aspiração respiratória, Vias respiratórias, Análise clínica