ObjectiveThe goal of this study is to evaluate the sensitivity and specificity of computed tomography (CT) scans in the diagnosis of foreign body aspiration (FBA) in children, and to determine whether chest CT scans would reduce the need for diagnostic rigid bronchoscopies.Data SourcesMEDLINE, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for relevant articles and conference proceedings that were published in English through November 1, 2022.Review MethodsWe included prospective and retrospective studies comparing chest CT scans and rigid bronchoscopy for the diagnosis of FBA in pediatric patients (<16 years old). The pooled estimates of the sensitivity and specificity of the chest CT scan in the diagnosis of FBA were calculated using a fixed‐ or common‐effects analysis and a random‐effects analysis that accounts for heterogeneity if present. Forest plots were constructed to combine the evidence identified during the systematic review.ResultsEighteen articles (4178 patients) were included. The average age of the children was 2.26 (±0.75) years, and 65% (±5.64%) of them were boys. Cough was the most prevalent symptom upon presentation. The pooled analysis showed that the sensitivity of chest CT scan in detecting a foreign body in children was 99% (95% confidence interval, CI [97, 100]; I2 = 72%, τ2 = 0.0065, p < .01). The false negative rate was 1.8% (95% CI [0.3, 2.7]; I2 = 72%, p < .01). The specificity of chest CT scan was 92% (95% CI [83, 98]; I2 = 83%, τ2 = 0.0437, p < .01).ConclusionsChest CT scan is a sensitive and specific test for the diagnosis of FBA in the pediatric population. Its use can help to reduce unnecessary rigid bronchoscopies, especially in patients with a low clinical suspicion of aspiration. It should not be a replacement for the gold standard bronchoscopy, particularly in cases where there is a clear history and symptoms suggestive of aspiration.
Introduction: We report a unique case of a patient with epithelioid hemangioma (EH) of the nasal cavity showing atypical histological features diagnosed using Next-Generation targeted RNA Sequencing that revealed a GATA6-FOXO1 fusion transcript.
The patient’s main concern and important clinical findings: It is a 53-year-old man who was experiencing recurrent episodes of right epistaxis. Nasal endoscopy revealed an exophytic well defined lesion at the head of the right middle turbinate.
The primary diagnosis, interventions, and outcomes: the lesion was resected endoscopically under general anesthesia. Microscopic examination revealed solid sheets of epithelioid tumor cells with some slit-like vascular channels with moderate to severe nuclear atypia. Tumor cells were positive for ERG, CD31, CD34 and GATA6 immunostainings. The proliferation index (Ki-67) was relatively high. A Next-Generation targeted RNA Sequencing shows a GATA6-FOXO1 fusion transcript confirming the diagnosis of epithelioid hemangioma with atypical features. No clinical recurrence was detected on nasal endoscopy during the 12 months follow-up period.
Conclusion:EH of the head and neck region is a diagnostic challenge for both head and neck surgeons and pathologists. The diagnosis is confirmed through histological and immunohistochemical analysis.
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