© Borgis - New Medicine 4/2012, s. 105-107
*Teresa Ryczer, Lidia Zawadzka-Głos, Mieczysław Chmielik, Patrycja Szczupak
The clinical characteristics and radiographic findings in patients with foreign body aspiration
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Introduction. Foreign body (FB) aspiration can lead to acute, life-threatening airway obstruction. Positive history of FB aspiration, clinical signs and symptoms with radiographic findings in a patient with suspected FB aspiration can help us to form diagnosis.
Material and methods. The retrospective analysis of clinical data of 67 patients, suspected of FB aspiration, that were hospitalized in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2008 to January 2012, was performed. We analyzed demographic and clinical characteristics, type of X-ray, radiographic findings, type and location of FB in airways.
Conclusions. The positive history of FB aspiration is an indication to perform bronchoscopy. In every case when FB aspiration is suspected, bronchoscopy should be performed. Anteroposterior or lateral decubitus chest X-ray findings can be helpful in the early stage of forming diagnosis. However, the negative chest X-ray does not exclude FB in respiratory tract. Anteroposterior chest X-ray has low sensitivity in patients with radiolucent airway FB.
Foreign body (FB) aspiration can be a life-threatening situation or can lead to chronic, non-specific symptoms (4). Foreign body inhalation is a potentially life-threatening emergency and is the commonest cause of accidental death in children under one year old (15).
MATERIAL AND METHODS
We analyzed clinical data of 67 patients, suspected of FB aspiration, that were hospitalized in the Department of Pediatric Otolaryngology of Medical University of Warsaw from January 2008 to January 2012. Demographic and clinical characteristics, type of X-ray, radiographic findings, type and location of FB in airways were taken into account.
In our study there was male predominance (boys n = 45, girls n = 22). The median age was 2 years (the average age was 3,24 years, the age ranged from 10 months to 16 years).
History of FB aspiration was present in 89% of patients (n = 60). In all patients (n = 67) with suspected FB aspiration bronchoscopy was performed. Positive bronchoscopic findings were present in 84% of cases (n = 56).
The most common clinical symptoms were cough (n = 26, dyspnea (n = 18), wheezing (n = 12), and fever (n = 80). The findings on chest auscultation stated by pediatrician were in most commonly asymmetric breath sounds (n = 25), wheezes (n = 23), ronchi (n = 13).
Posteroanterior chest X-ray was done in 80.6% of patients, whereas lateral decubitus chest X-ray in 30.1% of cases. Among patients that underwent lateral decubitus chest X-ray, most of them (85%) had previously PA chest X-ray. The most common radiological findings were emphysema (35%), mediastinal shift (14%), athelectasis (12%) and alveolar consolidations (10.5%). The normal chest X-ray was reported in 18% of patients. The sensitivity of PA chest X-ray was 67%, whereas the specificity was 46%. The sensitivity and specificity of lateral decubitus chest X-ray was subsequently 75% and 100%.
Right bronchus (50.8%, n = 29) was the most frequent location of extracted FB. Other locations were left bronchus (30%, n = 17), right and left bronchus (n = 3), lobar bronchi (n = 3), right/left bronchus and trachea (n = 2), trachea (n = 1).
Almost all of FBs were radiolucent in nature (n = 56). There was one radio-opaque FB which was a pin. The most common extracted FB was peanut (n = 43). Among other Fbs were a piece of apple (n = 4), a piece of plastic (n = 2), and a toy block, rubber, pin, whistle, pumpkin seed, a piece of bark, bead (n = 1).
The diagnosis of a bronchial FB can be accurately made in 83.5% of the cases in the presence of a positive history of possible aspiration, significant physical findings and supportive roentgenographic evidence (8). However, tracheobronchial foreign bodies should be strong suspected in pediatric patients who present with suggestive history of aspiration, even when physical and radiographic evidence is absent (1, 3).
In our study there was male predominance (boys n = 45, girls n = 22), which correlates with literature data (3, 12).
The highest incidence of FB in respiratory tract occurs between 1 and 3 years, the peak incidence of FB aspiration in children is between the ages of 1 and 2 years. It is the result of their increasing activity and curiosity, lessening of close parental supervision and in that period of life children have tendency to put objects in their mouths (3, 4, 6, 10-12, 14, 15). The median age in our group of patients was 2 years.
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