Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis?

Abstract

Objectives: To evaluate the yield of clinical and radiological features in the diagnosis of suspected foreign body aspiration in children and to assess factors associated with delayed diagnosis of foreign body aspiration. Study design and setting: Retrospective review of 10 years of experience in tertiary referral centre. Participants: Data were extracted from clinical records of children who underwent rigid bronchoscopy for suspected foreign body aspiration at the University of Nigeria Teaching Hospital Enugu from 2000 to 2009. Main outcome measures: Clinical features and radiological findings were validated against bronchoscopic findings. Results: Data of 103 children, (mean = 2.7 years, range =7 months to 14 years; 64% boys and 36% girls, were analysed. Majority (73%) were under 3 years of age. Foreign body aspiration was proven bronchoscopically in 85 (83%) patients. The most common symptoms were sudden choking crisis (74%) and paroxysms of cough (73%). Independent predictors of proven foreign body aspiration were witnessed aspiration, choking crisis and unilateral decreased breath sounds in univariate (P = 0.001, <0.001, and 0.001 respectively) and multivariable analyses (P = 0.02, 0.001, and <0.001 respectively). The most sensitive and specific clinical features were choking (86%) and witnessed aspiration episode (89%), respectively. Available chest radiographs revealed radio-opaque objects in 27% of patients. Delayed diagnosis of foreign body aspiration (>72 h) was significantly more in younger children (t = 3.29; P = 0.001), as well as in children with no history of witnessed aspiration, negative chest examination and radiological signs (P < 0.001, P = 0.02 and P = 0.04 respectively). Conclusion: To prevent the delayed diagnosis, witnessed aspiration, choking crisis, unilateral decreased breath sounds and radiopaque objects should be checked in all suspected cases. When history is doubtful, regardless of radiological findings, bronchoscopy can be strongly recommended in the presence of two factors.

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

“…(6,7) Regardless of the equipment used, bronchoscopy should be performed in all cases of suspected FB aspiration, even if the radiological findings are normal. (8,9) In our series of patients, 25% of the chest X-ray findings were normal, despite a clinical history of FB aspiration.…”

A university experience in foreign body aspiration

“…Rijid bronkoskopi, aspirasyonun hem tanı hem de tedavi amacıyla kullanılır. Anamnez veya fizik muayenede güçlü şüphe varsa radyolojik görün-tüleme yöntemleri normal bile olsa bronkoskopi yapılmalıdır (2). Trakebronşial yabancı cisimler sıklık-la kısa geniş ve daha dik açılanma gösterdiği için sağ ana bronşa yerleşme eğilimi gösterirken (6,7), çocuk-luk çağında bu durum erişkinlere göre daha az belirgindir (3).…”

Extraluminal Migration of Accidentally Ingested Foreign Body: An Unusual Case Report

“…as they have the capacity to create fistulas in surrounding structures. [8] Nature of the foreign body also plays a significant role in migration. Hard pointed foreign bodies like fish bones or wires have been reported to have migrated into the surrounding tissues without specific symptoms.…”