Diagnosis Of Foreign Body Aspiration Research Articles

Foreign body aspiration in children. The diagnostic value of signs, symptoms and pre-operative examination

One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.

The causes and complications of late diagnosis of foreign body aspiration in children: Liancai M, Ping H, Degiang S Arch Otol Head Neck Surg 117:876–878 Aug 1991

The causes and complications of late diagnosis of foreign body aspiration in children: Liancai M, Ping H, Degiang S Arch Otol Head Neck Surg 117:876–878 Aug 1991

The causes and complications of late diagnosis of foreign body aspiration in children : Mu L, He P, Sun D. Arch Otolaryngol. 1991;117: 876–879

The causes and complications of late diagnosis of foreign body aspiration in children : Mu L, He P, Sun D. Arch Otolaryngol. 1991;117: 876–879

The Causes and Complications of Late Diagnosis of Foreign Body Aspiration in Children: Report of 210 Cases

Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.

An appropriate negative bronchoscopy rate in suspected foreign body aspiration

Aspiration of foreign bodies in children can lead to illness and even death if not recognized and treated promptly. Seventy-six patients were referred to our hospital for suspected foreign body aspiration. The following is a retrospective review of their diagnosis and treatment. There was no foreign body found at bronchoscopy in seven patients (9 percent), and there were nine patients (12 percent) with bronchial foreign bodies who had a delay in diagnosis of foreign body aspiration. The delay averaged 35 days. These children, as a result of a prolonged period before diagnosis, were treated unnecessarily for pneumonia and asthma. Once correctly diagnosed, they had a significantly longer hospital stay. We propose that some negative bronchoscopies are necessary in order to prevent the morbidity that occurs from a missed foreign body aspiration.

The diagnosis of foreign body aspiration in childhood

A 10-year experience with the treatment of 157 children for foreign body aspiration is reviewed. The object of the review is to examine diagnostic accuracy and to differentiate between the clinical features of patients diagnosed early (within 24 hours) and late (beyond 24 hours) following the onset of symptoms. Diagnostic accuracy was found to be high. In 83.5% of patients the combination of clinical and radiologic signs correctly disclosed the site of foreign bodies within the tracheobronchial tree. In 80% of patients there was a history of witnessed choking, however, only 46% were diagnosed early. The diagnostic triad of wheezing, coughing, and decreased breath sounds was more common in late diagnoses (47%) than in early diagnoses (31%). The triad was incomplete in 61% of all patients. Radiologic findings were normal in one third of the patients diagnosed early and revealed atelectasis or consolidation in one half of those diagnosed late. With early diagnosis endobronchial inflammation was absent in 56% of patients compared with severe inflammation in 36% of late diagnoses. Right-side foreign bodies were more common (56%) and were diagnosed early 50% of the time compared with left-side foreign bodies which were diagnosed early only 35% of the time. Two thirds of tracheal and bilateral foreign bodies were diagnosed early compared with only one third of peripheral foreign bodies. This review indicates that most children with foreign body aspiration were diagnosed accurately. Although diagnoses can be made early; more than half of the patients were diagnosed late when there was evidence of significant airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Significance of Pulmonary Scintigraphy for the Detection of Endobronchial Foreign Bodies in Children

Radiolucent endobronchial foreign bodies are common in children and may be undetected because of normal physical findings and usually minimal X-ray abnormalities, thus delaying their removal.Recently we experienced 8 clinical cases in which the presence of radiolucent endobronchial foreign bodies were first suggested by the findings on the perfusion lung scanning.We can conclude that the perfusion lung scanning is useful in the diagnosis of foreign body aspiration in infants and children.

Bronchoscopy in childhood

One hundred and seventeen patients underwent 183 bronchoscopies with no fatalities. Thirteen patients had complications related to their bronchoscopy and not the underlying disease state. Only the 33 patients with a diagnosis of foreign body aspiration had a high (88%) correlation of the preoperative diganosis or condition and the postoperative findings. Fifty-one of the 117 patients had normal bronchoscopies and the number of normal bronchoscopies in patients who had wheezing, croup, hoarseness, stridor, and chronic cough was high. Assessing justification for bronchoscopies despite the negative correlation of pre- and postoperative diagnosis is difficult due to many factors, including pediatrician and parental anxiety, and the recognized consequences of missing a foreign body or other lesion in the airway of a child. Using liberal criteria for justification, fewer than 10% of the patients in this series had an unwarranted bronchoscopy, and the safety of the procedure would indicate that bronchoscopy in a pediatric medical center should be performed with minimal clinical justification.

In Reply: You Have to Use Endoscopy

Plastic foreign bodies in the trachea may be tricky, as Drs. Stool and Bluestone point out. We would not hesitate to use bronchoscopy on their patient either, since the history, physical examination, and roentgenograms all were equivo cal. Bronchoscopy was diagnostic as well as therapeutic. Postural drainage treatment is not appropriate without a diagnosis of foreign body aspiration. Stool and Bluestone correctly point out the hazard of migration of the foreign body, with the potential complication of glottic obstruction or spasm. See image in the PDF file

Lung scanning for the detection of endobronchial foreign bodies in infants and children. Clinical and experimental studies.

Striking perfusion deficits were noted on the lung scans of 5 children who, despite aspiration of radiolucent foreign bodies, had normal physical findings and usually minimal x-ray abnormalities. Seven dogs, studied after endobronchial placement of partially occluding foreign bodies, likewise displayed positive perfusion lung scans. Scans reverted to normal following foreign-body removal. Plain films, angiograms, and blood gas studies were unremarkable. The findings suggest that the perfusion disturbance related to partially occluding foreign bodies occurs at the capillary level. Perfusion lung scanning is useful in the diagnosis of foreign body aspiration and may be negative for as long as 24 hours after aspiration.

Management of Respiratory Foreign Body- A Twelve Years Experience with 382 Cases

Objectives: To evaluate the clinico-demographic profile and management of foreign body (FB) aspiration in hospitalized patients. Methodology: This was a retrospective study conducted at the National Institute of Diseases of the Chest and Heart (NIDCH), Dhaka during the period of October 1994 to February 2006. Medical records were used for collection of cases. The diagnosis of FB aspiration was made from documented presenting features, physical findings, investigations of chest radiology, CT scan whenever done and management outcome with rigid bronchoscopy and surgical interventions like bronchotomy or resection surgery. Results: Most of the patients 374 (97.5%) were children up to 15 years of age with the peak age of 1-10 years (81.3%). Males were affected more (63%) than females (37%). The majority of the patients (96%) were from poor socio-economic status. Most of the patients 297 (77.7%) presented early (within 7 days of aspiration) with cough and respiratory distress. There was late (after 7 days up to 12 years) presentation in 85 (22.2%) cases with respiratory complications. FB was found to be radio-opaque in 122 (31.9%) cases on chest imaging. Rigid bronchoscopy was attempted in all cases initially and it was successful to remove FB in 99.6% cases in patients who presented early. But it failed to remove the FB in 49 (57.6%) of cases when the patients presented late. Most of the FBs were of natural in origin 247 (64.6%) and the number of artificial FBs was less 135 (35.3%). FBs found impacted more on the right bronchial tree in 230 (60.2%), followed by left side in 121 (31.6%) and central airway in 31 (8.1%) cases. In failed cases, bronchotomy, lobectomy and pneumonectomy were the other modalities (57.6%) of management. Conclusion: Children of the age group 1-10 years were found most vulnerable for FB aspiration. FB of natural origin were common in our situation. FBs were impacted mostly on the right side. Removal of FB by rigid bronchoscopy was excellent when the patients presented early. Other difficult modalities of management like bronchotomy, lobectomy and pneumonectomy were needed in cases of late presentation. DOI: 10.3329/bjch.v30i1.6177 Bangladesh J Child Health 2006; VOL 30 (1/2/3): 12-16