Diagnosis Of Bronchial Foreign Body Research Articles

Multislice spiral computed tomography can independently predict the bronchoscopy results of children with bronchitis (pneumonia) suspected caused by bronchial foreign bodies.

BackgroundMultislice spiral computed tomography (MSCT) playsa vital role in the diagnosis of bronchial foreign bodies in children. Bronchitis (pneumonia) can be caused by bronchial foreign bodies in children, which need to be diagnosed and treated by bronchoscopy. To understand the application of MSCT in children with bronchitis (pneumonia) suspected to be caused by bronchial foreign bodies, the clinical data of 162 children were analyzed retrospectively.MethodsThe clinical data of 162 children with bronchitis (pneumonia) suspected to be caused by bronchial foreign bodies were collected, including sex, age, course of the disease, auscultation, chest X-ray, MSCT, bronchoscopy, among many others. Univariate logistic regression analysis analyzed the above other items, taking the finding of foreign bodies in bronchoscopy as the outcome index. The key variables of univariate analysis are included in multivariate logistic regression analysis to determine the independent influencing factors of bronchoscopy results.ResultsAmong the 162 patients, 70.4% were male, with the largest proportion of children aged 1–2 years (55.6%). The course of the disease of 98 cases (60.4%) was over14 days. A total of 111 cases (68.5%) showed positive auscultation, 110 cases (67.9%) showed positive chest fluoroscopy, 155 cases (95.7%) showed bronchial foreign bodies with MSCT, and the foreign bodies of 140 cases (86.4%) were removed by bronchoscopy. Univariate analysis showed that the course of the disease, chest auscultation, and MSCT were all correlated with the results of bronchoscopy. However, multivariate analysis showed, after adjusting the two factors of chest auscultation and chest fluoroscopy, the course of the disease (OR =6.01, 2.36–15.29, P<0.001) and MSCT (OR =95.64, 5.62–1,628.40, P<0.002) could still independently predict the results of bronchoscopy.ConclusionsMSCT can independently predict the results of bronchoscopy in children with bronchitis(pneumonia) suspected to be caused by bronchial foreign bodies.

Congenital lobar emphysema: the role of multislice computed tomography with virtual bronchoscopy in the differential diagnosis with bronchial foreign bodies

We read with great interest the well-written manuscript by Jung et al. [1], which reported their experience with multislice computed tomography (MSCT) and virtual bronchoscopic (VB) reconstruction for the diagnosis of bronchial foreign bodies (BFBs) in pediatric patients. They discussed the importance of an early diagnosis, as any delay may cause serious complications. Most (90 %) of their cases presented with hyperinsuXation of the aVected lung, but only 40 % had witnesses to the aspiration event. Furthermore, about 90 % of BFBs are radiolucent and clinical examination Wndings are generally nonspeciWc. We would like to report our experience with a case of congenital lobar emphysema (CLE), a congenital disease that can simulate BFBs clinically and radiologically. The patient was diagnosed using MSCT and VB. A 5-month-old male was referred to our pediatric emergency ward due to respiratory diYculty. Examination conWrmed that the infant was experiencing mild respiratory diYculty; the respiration rate was 80 breaths/min, the heart rate was 130 beats/min, the facies were normal, weight was 6.0 kg, and length was 75 cm. Cyanosis, jaundice, and signs of heart failure were absent. An examination of the respiratory system revealed reduced movement, decreased vocal resonance, and diminished breath sound on auscultation of the left upper chest. Other systems appeared normal. A chest X-ray showed overdistension of the left-upper lobe, with a mediastinal shift to the right. A CT scan showed hyperlucent segments of the left-upper lobe (attenuated but intact pattern of organized vascularity) with no substantial midline herniation (Fig. 1a, b). Three-dimensional volume rendering (Fig. 1c) showed a high degree of stenosis in the apicoposterior segment. VB (Fig. 1d) conWrmed the highgrade stenosis and excluded other bronchial abnormalities. The postoperative pathological diagnosis conWrmed this initial diagnosis. Congenital lobar emphysema, also referred to as congenital pulmonary overinXation, most commonly aVects a single lobe of the lung, although multiple lobes or speciWc lobar segments may be involved. The disease is characterized by progressive lobar overexpansion, usually with compression of the remaining (ipsilateral) lung. The underlying cause can be a deWcient bronchial cartilage, endobronchial lesions, or extrinsic airway compression (e.g., by a large pulmonary artery or bronchogenic cyst), resulting in airway luminal narrowing and obstruction with air trapping. Although the alveoli expand, the alveolar walls remain intact; therefore, the term emphysema is technically inaccurate [2, 3]. In conclusion, CLE should be included in the diVerential diagnosis of BFBs, because both may present with pulmonary hyperinsuXation Wndings and nonspeciWc clinical features. Multislice CT with reconstructions of the B. Hochhegger · G. Zanetti · E. Marchiori (&) Universidade Federal do Rio de Janeiro, Rua Thomaz Cameron, 438. Valparaiso, Petropolis, Rio de Janeiro CEP 25685.120, Brazil e-mail: edmarchiori@gmail.com

Diagnostic value of various investigations in children with suspected foreign body aspiration

Foreign body aspiration is a serious condition during childhood that requires prompt management to avoid complications and irreversible lung injury. Rigid bronchoscopy under general anaesthesia is the procedure of choice for removal of aspirated foreign bodies, but it can be associated with serious complications. The positive diagnosis can sometimes be challenging except in the case of radiopaque or obstructive foreign bodies, due to the low sensitivity and specificity of clinical history and physical examination. The aim of this review is to evaluate the various investigations in children with suspected foreign body aspiration, in order to reduce the negative rigid bronchoscopy rate. Review of the literature based on Medline data between 1980 and 2010. Chest radiography during inspiration and expiration, often performed as the first-line radiographic investigation, has a low sensitivity and specificity. In the absence of a radiopaque foreign body, obstructive emphysema is the most specific radiographic sign. Airway fluoroscopy can complete chest radiography when radiographic signs are nonspecific. Flexible bronchoscopy is the most sensitive and most specific examination, but is not always available, as it must be performed in the operating room or with resuscitation equipment at hand. This procedure should be performed when foreign body aspiration is suspected in the absence of typical clinical and radiological signs. It can decrease the number of negative rigid bronchoscopies. Several studies suggest that chest CT is also a very sensitive examination in this indication. The sensitivity and specificity of chest CT for the diagnosis of bronchial foreign body must be validated by a prospective study. A national multicentre study is currently underway to determine whether CT can replace flexible bronchoscopy when the diagnosis of bronchial foreign body is uncertain.

気管・気管支異物症例の検討

We analyzed 8 cases of bronchial foreign bodies in our hospital from 2003 to 2007. Patients' ages ranged from 9 months to 6 years old, with a mean of 2.3 years old. The ratio of males to females was 1:1. We detected abnormal findings such as atelectasis and emphysema in 5 patients by chest X-ray. However, in 3 patients, there were no abnormal findings. CT scan was able to clarify the localization of foreign bodies in all cases. Therefore, CT scan was useful for the diagnosis of bronchial foreign bodies. We removed the foreign bodies by ventilation bronchoscopy under general anesthesia in all cases. It was very important to observe the bronchus before and after the removal of foreign bodies using a flexible fiberscope to identify foreign bodies and remove them precisely. It is also very important for otorhinolaryngologists, anesthesiologists, pediatricians, etc., to work together in order to comprehensively treat bronchial foreign bodies.