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Role of expiratory chest X-ray in pediatric foreign body aspiration
Damien Moreau1, Jean-Noël Evain2, Guillaume Mortamet2
1Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, Cedex 09, France; Grenoble Alpes University, School of Medicine, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble, Cedex 9, France.
Insights
Expiratory chest X-rays significantly improve the detection of pediatric tracheobronchial foreign bodies, reducing the need for unnecessary endoscopies. This imaging technique offers high sensitivity and specificity in diagnosing airway foreign body aspiration.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Pulmonology
Background:
- Tracheobronchial foreign body aspiration is a critical pediatric emergency.
- Diagnosis can be challenging, often necessitating endoscopy under general anesthesia.
- The utility of expiratory chest X-rays in reducing endoscopies is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of expiratory chest X-rays in detecting airway foreign bodies in children.
- To assess the potential of this imaging strategy to minimize the need for diagnostic endoscopies.
Main Methods:
- Retrospective study of pediatric patients with suspected foreign body aspiration.
- Comparison of findings from standard chest X-rays and expiratory chest X-rays against endoscopy results.
Main Results:
- Adding expiratory chest X-rays increased positive radiographies from 27.1% to 52.9%.
- Only 2 out of 36 foreign bodies were missed, demonstrating high detection rates.
- Expiratory chest X-rays achieved a sensitivity of 94.4% and specificity of 91.1%.
Conclusions:
- Expiratory chest radiography is highly sensitive for detecting pediatric airway foreign bodies.
- This imaging modality can help avoid unnecessary endoscopies, especially in centers without MDCT access.
- Endoscopy should be reserved for cases with persistent clinical symptoms despite imaging findings.
Purpose:
Tracheobronchial foreign body aspiration is a common pediatric emergency and a leading cause of accidental deaths in children. The diagnosis remains sometimes difficult even with physical examination, medical history, and basic X-rays. This challenge necessitates the performance of endoscopy under general anesthesia, regardless of the potential for serious complications. The benefit of strategies like expiratory chest X-rays to reduce unnecessary endoscopies remains uncertain. We evaluated the effectiveness of expiratory chest X-rays in detecting airway foreign bodies to potentially reduce the need for endoscopies.
Methods:
We retrospectively studied children with suspected foreign body aspiration who had X-ray and endoscopy.
Results:
A total of 70 children were included in the study. Out of these, 19 cases (27.1 %) showed pathological findings on standard chest X-rays. However, when expiratory chest X-rays were added, the number of pathological radiographies increased to 37 cases (52.9 %). Out of the 36 foreign bodies that were present, only 2 were not detected. Furthermore, 3 chest X-rays displayed pathological results, while the endoscopies indicated normal findings. Consequently, the overall sensitivity, specificity, positive predictive value, and negative predictive value stood at 94.4 %, 91.1 %, 91.9 %, and 93.9 % respectively.
Conclusion:
The remarkable sensitivity of expiratory chest radiography can eliminate the need for unnecessary endoscopy, but it should be limited to centers lacking access to MDCT. The performance of endoscopy should only be considered when persistent clinical symptoms are observed during auscultation.
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