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Our objective was to report on two new chest X-ray signs (hyperinflation or obstructive emphysema with atelectasis in the same hemithorax, and aeration within an area of atelectasis) in children with foreign-body aspiration (FBA). We performed a retrospective review of clinical characteristics and chest X-ray films of 133 children with FBA. Of 133 children, 45% were under 3 years old. History of a choking crisis was present in 101 (75.8%); however, it was only elicited upon follow-up questioning in 33 children (32.7%). Early foreign-body (FB) extraction (<24 hr) was performed in 17.3%; removal took place between 1-7 days in 29.3%. The site of aspirated FBs was bronchial in 78.9%, laryngeal in 6%, and tracheal in 4.5%, with mobile FB in the trachea/bronchi in 4.5%. The chest X-ray was normal in 11.3%. Positive findings included: radiopaque FB (23.3%); hyperinflation or obstructive emphysema (21.8%); hyperinflation or obstructive emphysema with atelectasis in the same hemithorax (18%); lobar atelectasis (12.8%); whole-lung atelectasis (6.8%); shift of mediastinal shadow (11%); and aeration within an area of atelectasis (6%). In conclusion, if a history of choking crisis is not present in a child with suspected FBA, two previously undescribed radiological signs (hyperinflation or obstructive emphysema with atelectasis in the same hemithorax, and aeration within an area of atelectasis) should be sought in order to improve the utility of chest-X ray for early diagnosis of FBA.

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The main purpose of this study was to evaluate four different forms of treatment in young infants admitted for acute wheezing (AW). Seventy-nine infants less than one year of age were randomly assigned to one of five groups. Group 1 received nebulized fenoterol plus ipratropium bromide, group 2 fenoterol, group 3 fenoterol plus steroids, and group 4 aminophylline, IV, plus steroids and oral fenoterol; the control group, or group 5, received nebulized normal saline solution. Clinical evaluation was done by means of a scoring system. The effectiveness of treatments was estimated by a score decrease in the first 24 hours, by the percentage of patients whose scores did not decrease during the same period, and by the number of days in the hospital. All infants had significantly decreased scores, except those in the control group; the aminophylline group included a greater percentage of patients who did not abate their scores, and they stayed in the hospital for more days than those in the other groups. The fenoterol group had the shortest hospital stay. All four treatments produced objective clinical improvement in bronchial obstruction. However, the nebulized bronchodilator treatments were more effective than aminophylline IV in decreasing scores on the first day, and they resulted in shorter hospitalization.