Flexible bronchoscopy in diagnosis and removal of foreign body aspiration in children

Abstract

Aim: To investigate epidemiological data of foreign body aspiration (FBA) over a 25 year period and define the sensitivity and specificity of clinical and radiological findings on diagnosis. Methods: We performed a retrospective study reviewing the clinical records of 176 children (mean age: 3.03 years, 60.8% male) who underwent flexible bronchoscopy for suspected FBA, over a period of 25 years. Results: FBA was confirmed with bronchoscopy in 78 cases (44.3%), (mean age 2.74, range: 6 months-10 years, 61.5% males). The majority of the foreign bodies were nuts (52.0%), followed by other food particles (16%) and seeds (14%). The foreign body was located predominantly in the right bronchial tree (56%). The average time between aspiration and diagnosis was 16 days (range: 1 day – 4 years), with the most common clinical signs and symptoms being cough (76.5%), reduced air entry (62.9%) and wheezing (28.6%). This triad was present in 20.6% of the patients. The most frequent radiological finding was unilateral hyperinflation (56.5%) followed by opacities (20.3%) and atelectasis (10.1%). Eighteen patients (23%) presented with normal X-rays. Most of the foreign bodies were removed with a rigid bronchoscope by ENT; over the last 5 years there has been an increasing trend to remove the inhaled foreign body with a basket through the flexible bronchoscope (15 cases). Conclusions: The clinical symptoms and the radiological findings alone are not sufficiently specific and sensitive in the diagnosis of FBA; children who present with a history of suspected FBA, should undergo diagnostic flexible endoscopy.