Foreign body aspiration in children. The diagnostic value of signs, symptoms and pre-operative examination

Abstract

One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.

Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico

“…In our sample, the principal primary complication was pneumonia, as previously described in other Anatomically, the right bronchus, due to its greater verticality and larger diameter, favors the entry of a foreign body. (21) In the present study, we observed a predominance of the location of the foreign bodies were more often lodged in the right bronchus than in the left bronchus (54.8% vs. studies. (5,11,16) Procedure-related complications, such as barotrauma, occurred in only 2 patients.…”

“…(15) This finding appears to have high specificity in FBA, (21,22) being present in more need for a second procedure in order to remove the foreign body (p < 0.05). In relation to the subsequent follow-up evaluation, 51 children were discharged from the hospital, and 18 (26%) returned as outpatients, the follow-up period ranging from 1 to 98 months (median, 3 months).…”

Usefulness of virtual bronchoscopy in evaluation of suspected foreign body in tracheobronchial tree

“…14 The sensitivity of a chest radiograph in diagnosis of FB aspiration is 82% and specificity 44%. 15 Chest radiography is the preferred initial investigation in cases of tracheobronchial FB aspiration. Unfortunately, almost 90% FBs are radioluscent and 30% of the chest radiographs inconclusive.…”

The diagnosis and management of chronic cough

“…Aspirated foreign bodies may go unrecognised for prolonged periods of time, especially if the diagnosis is missed initially [91]. Foreign body aspiration is much more common in young males than in young females, and is especially frequent in children aged v4 yrs.…”