Ref Number = PITIKA-ASPR0320
Anton Dharma Saputra, Madeleine Ramdhani Jasin, Darmawan Budi Setyanto
Foreign body (FB) aspiration is a worldwide health problem which often results in life threatening complications. Chest radiography can provide information regarding the location and characteristics of FB. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. Rigid bronchoscopy is the modality of choice for FB retrieval as it maintains the airway patency. Limitation and availability of rigid bronchoscopy result in utility of flexible bronchoscopy as an alternative in management of respiratory tract FB. 

Case 1: an 11-year-old girl complained of accidentally choked on a headpin, neither breathing difficulties nor pain was observed. She was able to eat and drink as usual.  Chest radiograph revealed a radioopaque FB in left main bronchus. The exact location of headpin was confirmed with bronchoscopy. Initially, rigid bronchoscope was used but failed to reach the headpin, then flexible bronchoscope was utilized to perform FB removal. 
Case 2: a 1-year-old boy with history of choking while eating catfish came with productive cough 3 weeks prior to admission. He also developed sore throat, hoarseness and increased saliva. No shortness of breath nor fever. There was delayed in diagnosis and treatment despite being managed by two local hospitals. Patient then transferred to our hospital for further management. Chest radiography showed a radioopaque FB in trachea. Unfortunately, rigid bronchoscopy was unavailable at that moment, and flexible bronchoscopy was used to confirm the location. Fishbone was seen on distal trachea, and was successfully extracted after the third attempt and pulled out through paralyzed vocal cord. 
No serious complication was seen in both cases.

Early recognition and intervention are imperative for the successful management of respiratory tract FB. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. Flexible bronchoscopy for respiratory tract FB can be safely used as an alternative for rigid bronchoscopy. 
Keywords: Bronchoscopy, respiratory foreign body extraction, flexible, rigid
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