Use of virtual bronchoscopy in children with suspected foreign body aspiration

Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30% of such patients. Tomography-generated virtual bronchoscopy (VB) can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory symptoms and history of cough or choking with foods before these symptoms. Both patients were submitted to VB. In both cases, we detected an endobronchial foreign body, which was then removed by conventional rigid bronchoscopy in one of the cases. Only recently developed, VB is a noninvasive imaging method that has potential for use in detecting foreign bodies in the airways of children. In select cases, VB can indicate the exact location of the foreign body and even preclude the need to submit patients to rigid bronchoscopy in the absence of a foreign body.