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A Diagnostic Dilemma for the Pediatrician: Radiolucent Tracheobronchial Foreign Body
Hakan Taşkınlar1, Gökhan Berktuğ Bahadır1, Cankat Erdoğan1
1Department of Pediatric Surgery, School of Medicine, Mersin University, Yenişehir Mersin, Turkey.
Insights
Clinical history, physical exams, and imaging are unreliable for detecting radiolucent foreign body aspiration in children. Bronchoscopy is recommended for suspected cases, even with normal findings, to ensure accurate diagnosis and treatment.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Radiolucent foreign body aspiration is a significant concern in pediatric patients.
- Accurate diagnosis is crucial for timely intervention and preventing complications.
Purpose of the Study:
- To evaluate the diagnostic utility of clinical history, physical examinations, and radiological findings in suspected radiolucent foreign body aspiration.
- To determine the role of bronchoscopy in diagnosing these cases.
Main Methods:
- Retrospective analysis of 236 children under 18 who underwent rigid bronchoscopy for suspected radiolucent foreign body aspiration (1999-2015).
- Evaluation of sensitivity, specificity, and predictive values of clinical history, physical examinations, and radiological findings.
Main Results:
- Foreign bodies were found in 52.9% of cases, predominantly organic (78%) and in children under 3 years (71.1%).
- Sensitivity and specificity were highest for clinical history (98.4%, 54.9%) but low for physical exams (47.2%, 74.7%) and radiology (35.2%, 92.7%).
Conclusions:
- Clinical history, physical examinations, and radiological findings have limitations in detecting radiolucent foreign body aspiration.
- Bronchoscopy is essential for children with witnessed choking events, irrespective of initial clinical or radiological findings.
Background:
The purpose of this study is to determine the role of clinical history, physical examinations, and radiological findings in the evaluation of patients with suspected radiolucent foreign body aspiration.
Methods:
The medical records of 236 children (under the age of 18 years), on whom a rigid bronchoscopy was performed between 1999 and 2015 because of suspected radiolucent foreign body aspiration, were analyzed retrospectively. Sensitivity, specificity, positive and negative predictive values of clinical history, physical examinations, and radiological findings were evaluated.
Results:
In 71.1% of all cases, the children were under the age of 3 years. The bronchoscopy showed the presence of a foreign body in 52.9% of cases, with the locations of the foreign bodies being as follows: (1) right main bronchus, 47.2%; (2) left main bronchus, 36.0%; (3) trachea, 11.2%; (4) both bronchi, 5.6%. Organic foreign bodies were found in 78% of the patients, whereas inorganic foreign bodies were detected in 22% of the patients. The sensitivity and specificity of clinical history, physical examinations, and radiological findings were 98.4% and 54.9%, 47.2% and 74.7%, and 35.2% and 92.7%, respectively.
Conclusion:
Tracheobronchial foreign body aspirations usually occur prior to the age of 3 years, with the most frequently aspirated foreign bodies being food or items of a radiolucent nature. Clinical history, physical examinations, and radiological findings are not able to detect the presence of a radiolucent foreign body aspiration in children. Therefore, a bronchoscopy should be performed on children in whom a choking event has been witnessed, even in cases of normal radiological and clinical findings.
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