Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography

Area of Science:

• Pulmonary Medicine
• Diagnostic Imaging
• Interventional Pulmonology

Background:

• Bronchoscopy is the standard for foreign body aspiration (FBA) diagnosis and treatment.
• Bronchoscopy carries risks including invasiveness, airway reactivity exacerbation, and general anesthesia.
• Computed tomography (CT) may help identify FBA and avoid unnecessary bronchoscopies, especially in patients with reactive airways.

Purpose of the Study:

• To evaluate the diagnostic accuracy and reliability of CT in identifying foreign body aspiration.
• To determine if CT can improve the diagnostic yield of subsequent bronchoscopies.

Main Methods:

• Retrospective comparative study of 133 patients evaluated for FBA from June 2012 to September 2018.
• Analysis of clinical history, exam findings, radiographic findings, and operative findings.
• All CT scans were reread by three radiologists; a telephone survey was conducted for patients who had CT without bronchoscopy.

Main Results:

• CT demonstrated a foreign body in 18 patients, with 94.4% confirmed by bronchoscopy.
• Bronchoscopy alone identified FBA in 60.9% of patients.
• CT excluded FBA in 49 patients with 100% sensitivity and 98% specificity; interobserver reliability was excellent (κ=0.88).

Conclusions:

• CT is an accurate and reliable tool for diagnosing foreign body aspiration.
• Utilizing CT can increase the positive yield of bronchoscopy and potentially reduce invasive procedures.