The value of radiography for diagnosis of airway foreign bodies in children

Introduction: Tracheobronchial foreign body aspiration (FBA) is a major emergency in children. Early clinical, radiological and endoscopic diagnosis is essential to prevent complications, irreversible lung damage, and even death. Aims: Assessment of radiology usefulness for diagnosis airway foreign bodies in children. Methods: Analytical cohort study analyzing data for 93 children with FBA, which were evaluated by chest X-rays before bronchoscopy. Results: A choking episode was recorded in 62,4%: 95CI, 51,7-72,2, cough was present in 97,8%: 95CI, 92,4-99,7 cases, dyspnea -77,4%: 95CI, 67,6-85,4, wheezing -55,9%: 95CI, 45,2-66,2, cyanosis -15,1%: 95CI, 8,5-24. Radiological findings included: atelectasis syndrome in 18,3%: 95CI, 11-27,6 children (right segmental atelectasis in 9.63%, left lung 5.35%, middle lobe atelectasis 3.22%); localized obstructive emphysema in 31,2%: 95CI, 22-41,6 (middle lobe 3.2%, right lower lobe 19.3%, left lower lobe 9.7%). In 95.7%: 95CI, 89.4-98.8 children, FBA was radiologically manifested by pneumonic opacity. The average duration from aspiration to hospitalization was 11.68 ± 0.53 days with variations from 2 to 37 days. The most common localization of the foreign bodies was the right lower bronchus (51.61%), followed by the lower left bronchus (38.7%), the middle bronchus (6.45%) and the trachea (3.24%). Conclusions: In tracheobronchial FBA in children, the chest radiography is informative for each second case by segmental atelectasis syndrome or localized hyperinflation associated with the movement of the mediastinum, which in a clinical context are suggestive for the diagnosis of this accidental phenomenon and argues for performing bronchoscopy.