Tracheobronchial Foreign Bodies in Children: Imaging Assessment

Hegde, Shilpa; Hui, Peter Kei Tat; Lee, Edward Y.

doi:10.1053/j.sult.2014.10.001

Cited by 39 publications

(34 citation statements)

References 41 publications

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“…Although use of CT for "virtual tracheobronchoscopy" in pediatric patients has been reported in the literature for nearly two decades [22], it has been used exceedingly sparingly in the diagnosis of FBA, with multiple studies reporting only a handful of patients who undergo CT [7,10,12,13,15,18,23]. When used, it has been shown to be superior to plain films at detecting radiolucent foreign bodies [20]. Behera et al evaluated patients who had a CT and bronchoscopy for FBA, and found that 59/60 were confirmed, representing a positive-predictive value of 98.3% [19].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the clinical picture is often less clear, and the provider must decide which patients should undergo bronchoscopic evaluation. Plain films are used routinely (90%-100% of patients), but do not exclude the diagnosis, as approximately one-third of patients with FBA will have a normal chest X-ray (CXR) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Algorithms and multivariable models utilizing history, physical exam, and plain films still only reach sensitivity and specificity of approximately 70% and 60%, respectively [16,17].…”

mentioning

confidence: 99%

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Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography

Gibbons

Berazaluce

Hanke

et al. 2020

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography

Gibbons

Berazaluce

Hanke

et al. 2020

Journal of Pediatric Surgery

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“…Review of the last 15 years of literature revealed several papers related to the use of CT in the diagnosis of FBA [2,[5][6][7][8][9][10][11][12][13][14]. The focus has generally been on the reduction of false positives or negatives compared with conventional techniques to minimize the number of bronchoscopies performed.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of foreign body aspiration with ultralow-dose CT using a tin filter: a comparison study

et al. 2020

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Purpose Suspected airway foreign body aspiration (FBA) is a common event in paediatric emergency units, especially in children under 3 years of age. It can be a life-threatening event if not diagnosed promptly and accurately. The purpose of this study is to compare the diagnostic performance of an ultralow-dose CT (DLP of around 1 mGycm) with that of conventional radiographic methods (fluoroscopy and chest radiography of the airways) in the diagnosis of FBA children's airways.Methods Retrospective cross-sectional study. Data from 136 children were collected: 75 were examined with conventional radiographic methods and 61 with ultralow-dose CT. Effective doses were compared using independent t tests. The results of bronchoscopy, if performed, were used in creating contingency 2 × 2 tables to assess the diagnostic performance between modalities. An extra triple reading of all images was applied for this purpose.Results The effective doses used in the ultralow-dose CT examinations were lower compared with those in conventional methods (p < 0.001). The median dose for CT was 0.04 mSv compared with 0.1 mSv for conventional methods. Sensitivity and specificity were higher for ultralow-dose CT than those for conventional methods (100% and 98% versus 33% and 96%) as were the positive and negative predicted values (90% and 100% versus 60% and 91%). Conclusion Ultralow-dose CT can be used as the imaging of choice in the diagnosis of airway FBA in emergency settings, thereby avoiding concerns about radiation doses and negative bronchoscopy outcomes.

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“…Potential causes of a false-positive CT examination for an airway FB include an endobronchial mucus plug, or tumor, whereas false-negative CT examinations may occur in the setting of an FB that is too tiny to resolve or is obscured by motion artifact or other technical limitation. 3 Several publications report the diagnostic efficacy of CT in the diagnosis of pediatric FBA. Bhat et al 4 The 20 children with a normal CXR underwent chest CT as well as DL&B. Thirteen of these 20 children had an FB identified by DL&B; only 1 case of a "minute" FB was missed by CT.…”

Section: Introductionmentioning

confidence: 99%

“…This diagnostic performance of CT is much superior to CXR, in which most airway FBs are radiolucent and not directly visualized. 3 The presence of an airway FB on CXR is usually inferred from secondary signs such as air trapping on expiratory or decubitus views. These signs are not consistently present, and up to 37% of CXRs are normal in the setting of an airway FB.…”

Section: Introductionmentioning

confidence: 99%