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Paper text:
beads are difficult to remove due to smooth and spherical shape which can not be broken into pieces and difficult to hold with forceps .
fogarty catheter has been used between foreign body ( fb ) and bronchus wall as well as through fb for removal .
we report the use of c - arm - guided fogarty catheter insertion through bead for removal from bronchus in a child .
an eight - year - old healthy child presented with a complaint of recurrent cough for 3 days with a history of child playing with beads . on examination , there was decreased air entry on right side .
x - ray showed fb in the right main bronchus [ figure 1 ] . apart from high white cell count , blood reports were normal , and rigid bronchoscopy was planned .
monitoring , anesthesia induced with injection glycopyrrolate , ketamine , propofol , and atracurium with controlled ventilation . rigid ventilating bronchoscope confirmed plastic bead in the right main bronchus .
removal attempted using forceps , which failed due to spherical shape , large size , and smooth surface [ figure 2 ] .
next , fogarty catheter tried to insert between bronchus and fb , which also failed due to snuggly fitting bead .
finally , 4f fogarty catheter passed through the bead , balloon was inflated and while trying to pull fb , resulted in rupture of balloon . on second attempt , new fogarty catheter was inserted with the help of c - arm to confirm that fogarty catheter is adequately passed beyond bead , there is no overinflation of balloon and withdrawal was done slowly . bead was removed successfully as a unit with fogarty catheter and scope together [ figure 3 ] .
at the end of the procedure , co2 was adequately washed out , and anesthesia was reversed .
fb aspiration is leading cause of accidental death in young children below 3 years of age .
clinically , they may present with cough , unilateral wheeze , and decreased breath sounds which seen in only 65% patients . any patient with a positive history , classical symptoms , or radiological evidence needs intervention .
proper sizes bronchoscopes , expert clinicians , and all necessary preparations for open surgery are essential .
oxygenation is usually well maintained with ventilating bronchoscope , but ventilation is inadequate due to leak .
premedication with glycopyrrolate is desirable . occasionally , fb removal is difficult due to large size , spherical , or sharp objects . breaking fb and tracheotomy
large bronchoscope size , prolong procedure , and repeated attempt can lead to airway edema .
fogarty catheter is used mainly to remove distal fb , or along with grasping forceps when fb is large where catheter is passed between fb and bronchus . in fb such as bead
fogarty catheter can lead to complications such as rupture and embolism mainly due to blind procedure and excessive force applied during withdrawal . while there is no ideal anesthesia technique and
no outcome difference between spontaneous or positive pressure ventilation , controlled ventilation is more effective . in our case
there was also risk of dislodgment during removal , which can go to either bronchus .
fogarty catheter balloon got ruptured during withdrawal , which could be due to excessive force or overinflation . on the second attempt , new catheter passed under c - arm guidance to make sure that balloon is passed beyond bead , balloon was inflated with a smaller amount , and withdrawal was done under c - arm guidance .
if endoscopic removal fails , then open airway surgery was only option , which carries high risk .
. it should be done in a tertiary care center where all possible interventions can be carried out .
careful diagnosis , planning , availability of resources , and expert clinician are essential for safe management .
foreign body aspiration is still a cause of significant morbidity in children . 
 complications occur due to difficulty in diagnosis and treatment . 
 an eight - year - old child presented with a history of recurrent cough for 3 days . 
 rigid bronchoscopy under general anesthesia revealed plastic bead occupying right main bronchus . 
 removal with grasping forceps failed for several times due to spherical , smooth , and large bead . 
 finally , fogarty catheter was passed through bead under c - arm guidance and successfully removed .