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The use of CT-scan in foreign body aspiration in children: A 6 years' experience
Vincent Pitiot1, Margaux Grall1, Dominique Ploin2
1Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France; Claude Bernard Lyon1 University, Lyon, Rhone, France.
Insights
Computed tomography (CT) scans offer a reliable alternative to rigid bronchoscopy (RB) for diagnosing foreign body aspiration in children. This imaging technique helps avoid unnecessary invasive procedures, improving patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Pulmonology
Background:
- Foreign body aspiration is a common and risky pediatric emergency.
- Rigid bronchoscopy (RB) is the standard diagnostic and therapeutic procedure but carries a 4-17% complication risk.
- Advances in CT scanning offer potential as a less invasive alternative.
Purpose of the Study:
- To evaluate the reliability of cervical-thoracic CT with multiplanar reconstruction as an alternative to RB for diagnosing foreign body aspiration in children.
Main Methods:
- Retrospective analysis of 6 years (May 2010 - May 2016) at a tertiary referral center.
- Included 200 children with suspected foreign body aspiration who underwent cervical-thoracic CT.
- Compared CT findings with subsequent RB results where performed.
Main Results:
- CT scan identified foreign bodies in 68 of 200 children, with RB confirming 59 cases (83.8% PPV).
- Of 132 children with normal CT scans, 27 underwent RB with negative findings.
- The CT scan demonstrated a negative predictive value (NPV) of 99.2%, with one false negative case identified.
- One child with initial normal CT was later diagnosed with a foreign body, highlighting a potential limitation.
Conclusions:
- CT scan with multiplanar reconstruction is a reliable alternative to rigid bronchoscopy for suspected foreign body aspiration.
- CT imaging can help reduce the number of negative endoscopies, particularly in asymptomatic patients.
- This approach enhances diagnostic safety and efficiency in pediatric foreign body aspiration cases.
Introduction:
A foreign body aspiration is a risky situation, common in pediatric emergency. The "gold standard" to rule out a foreign body or proceed to its extraction, is rigid bronchoscopy (RB) under general anesthesia. However, RB is an intrusive exam with possible complications. Depending on authors, RB in emergency is a procedure at risk of complications in 4-17% of cases. Advances in radiology allow CT-scanners of fast acquisition and high definition, which could be used as an alternative to RB.
Materials And Methods:
This is a retrospective analysis of 6 years from May 2010 to May 2016, in a tertiary referral center. All children that presented a foreign body aspiration suspicion and had a cervical-thoracic CT with multiplanar reconstruction were analyzed.
Results:
200 children were included. The average age was 30 months. 132 were considered normal and 68 pathological. Among the 68 RB performed for pathological scanner, a foreign body was found in 59 cases, and we had 9 cases of false positives. Among the 132 considered normal, 27 have had a RB despite this, due to persistent symptoms, all were negative; 105 were discharged home without endoscopy with monitoring instructions. 1 child was reviewed three months later for asthma, without second choking event reported. A new CT-scan found a foreign body that was removed by RB. Due to the nature of the foreign body it is very unlikely to link it to the first choking event, but retrospectively we cannot be certain. Considering this case as the only false negative, the negative predictive value (NPV) of CT was 99.2% and positive predictive value (PPV) of 83.8%.
Conclusion:
The use of CT -scan with multiplanar reconstruction in suspected foreign body aspiration is a reliable alternative to endoscopy under general anesthesia, especially in asymptomatic patients, avoiding too many negative endoscopies.
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