Removal of an aspirated foreign body with a flexible cryoprobe.

Foreign-body aspiration is a common problem in children and adults worldwide. Foreign-body aspiration is more frequent in children than in adults; approximately 80% of recognized cases occur in patients younger than 15 years of age.1 However, especially elderly and nursing home patients often present with lung complications after unseen foreign-body aspiration. Typical symptoms of foreign-body aspiration are sudden onset of dyspnea, cough, choking, and vomiting. However, these symptoms vary, and in most cases they are even absent, and acute presentation in adults is rare. Moreover, the relatively low diagnostic accuracy of chest radiography often delays accurate diagnosis. No prospective study has evaluated the diagnostic utility of clinical and radiographic abnormalities in adults with suspected foreign-body aspiration. Furthermore, the often false assumption of community-acquired pneumonia and subsequent initiation of antibiotic treatment wastes time and increases mortality in these patients. In 1897, Gustav Killian started the era of bronchoscopy when he extracted a pork bone from the trachea of a German farmer, using an esophagoscope.2 Since that time, and because of ongoing technical achievements, fiberoptic bronchoscopy has become the cornerstone of the diagnostic evaluation of adults and children with suspected foreign-body aspiration. Rigid bronchoscopy remains the standard of care for removal of foreign bodies, except in selected situations. The case reported below shows typical clinical findings of a delayed diagnosis of foreign-body aspiration and introduces the flexible cryoprobe as a new technique for foreign-body removal. The flexible cryoprobe we used (Erbokryo, ERBE Cryosurgery, Tübingen, Germany, Fig 1A-D) can be used with a rigid bronchoscope under general anesthesia, but also with the flexible technique in combination with a 7.5-mm or 8.5-mm flexible tube (Bronchoflex, Rusch/Teleflex Medical, Germany) that has separate oxygen tubing, under local anesthesia and sedation. Freezing of the cryoprobe’s tip is achieved with the JoulesThomson effect: nitrous oxide is decompressed at the tip of the probe, which generates immediate cooling of the tip, theoretically to 89°C. In general we use the following interventional technique: