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[Small foreign bodies in the lungs of children--treatment or observation?]
1Sinsen legesenter Mailundveien 23 0569 Oslo.
Insights
Diagnosing foreign body aspiration in young children can be challenging. Normal X-rays do not rule out inhaled foreign bodies, necessitating careful follow-up and consideration of bronchoscopy.
Area of Science:
- Pediatric Pulmonology
- Pediatric Emergency Medicine
- Diagnostic Imaging
Background:
- Foreign body aspiration is a common pediatric emergency.
- Early diagnosis and intervention are crucial for favorable outcomes.
- Subtle presentations can lead to delayed diagnosis.
Observation:
- Three children under three years old presented with suspected foreign body aspiration.
- Initial symptoms were minor, and chest X-rays were normal.
- Discharge occurred despite clinical suspicion of foreign body inhalation.
Findings:
- Two children spontaneously expelled inhaled foreign bodies (tape and popcorn) after days to weeks.
- One child required bronchoscopic removal of a plastic pearl after six months.
- Chest X-rays have limited sensitivity for detecting small inhaled foreign bodies.
Implications:
- Normal chest X-rays should not exclude foreign body aspiration in symptomatic children.
- A short period of observation for spontaneous expulsion may be considered for mild cases.
- Close follow-up and consideration of bronchoscopy are vital for suspected foreign body aspiration.
Abstract:
The diagnosis of foreign body aspiration may easily be missed. Three children younger than three years of age inhaled, respectively, popcorn, a plastic pearl, and a piece of tape to the lungs. The children were admitted to the paediatric department under strong clinical suspicion of foreign body inhalation, but were discharged with minor symptoms and after normal X-ray investigation. Two of the children expelled their foreign body (tape and popcorn) after three days and three weeks, respectively, whereas the plastic pearl was removed by bronchoscopy after six months. X-ray investigation of the lungs are of limited value in the exclusion of presence of small inhaled foreign bodies. Children with minor symptoms suspected of having inhaled foreign bodies may possibly be observed for a short period in order to see if the foreign body is expelled spontaneously. However, the children should be carefully followed up, and bronchoscopy should be considered at all times.