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[Chest radiograph of foreign bodies in the tracheobronchial tree]
N Tomiyama1, S Morimoto, N Takeuchi
1Department of Radiology, Osaka University School of Medicine.
Insights
Foreign body aspiration in children can cause lung hyperlucency, especially early after the event. Advanced stages may show atelectasis or consolidation, necessitating further imaging for diagnosis.
Area of Science:
- Pediatric Radiology
- Pulmonology
Background:
- Foreign body aspiration is a common pediatric emergency.
- Timely diagnosis is crucial for effective management.
Observation:
- Chest radiographs of 14 children with tracheobronchial foreign bodies were reviewed.
- Common materials included nuts, often lodged in main bronchi.
Findings:
- Early signs (within 7 hours) included lung hyperlucency and overinflation.
- Later signs (after 18 hours) showed atelectasis or consolidation.
- Air-trapping was identified in indeterminate cases using expiratory views or fluoroscopy.
Implications:
- Lung hyperlucency suggests early-stage foreign body aspiration.
- Atelectasis or consolidation indicates a more advanced stage.
- Additional imaging is recommended for suspected foreign bodies, even with normal initial radiographs.
Abstract:
Chest radiographs in 14 children with foreign bodies in the tracheobronchial trees were evaluated retrospectively. The most common causative materials were nuts, and both main bronchi were most commonly involved. The initial chest radiographs that were used for analysis were obtained one hour to 50 days after aspiration or onset of symptoms. Of the nine cases in which chest radiographs were taken within 7 hours after aspiration, six showed hyperlucency with (three cases) or without overinflation (three cases) in the affected lungs, and the other three showed normal chest radiographs. Two patients had indeterminate diagnoses on chest radiographs at inspiration: one patient underwent chest radiographs at expiration and the other underwent fluoroscopy. Air-trapping was demonstrated in both patients. Of another five cases in which chest radiographs were taken 18 hours after aspiration of a foreign body, three cases showed atelectasis or consolidation and the other two showed hyperlucent lung. From these observations, hyperlucent lung indicates an early stage of the disorder while atelectasis or consolidation indicates a fairly advanced stage. In patients with clinically suspected foreign bodies, we advocate that additional examinations be performed to establish a final diagnosis, even when chest radiographs are normal or indeterminate.