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El Khoury P, Makhoul M, El Hadi C, Haber C, Rassi S. CT Scan in Children Suspected of Foreign Body Aspiration: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:1-12. [PMID: 37473440 DOI: 10.1002/ohn.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The goal of this study is to evaluate the sensitivity and specificity of computed tomography (CT) scans in the diagnosis of foreign body aspiration (FBA) in children, and to determine whether chest CT scans would reduce the need for diagnostic rigid bronchoscopies. DATA SOURCES MEDLINE, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for relevant articles and conference proceedings that were published in English through November 1, 2022. REVIEW METHODS We included prospective and retrospective studies comparing chest CT scans and rigid bronchoscopy for the diagnosis of FBA in pediatric patients (<16 years old). The pooled estimates of the sensitivity and specificity of the chest CT scan in the diagnosis of FBA were calculated using a fixed- or common-effects analysis and a random-effects analysis that accounts for heterogeneity if present. Forest plots were constructed to combine the evidence identified during the systematic review. RESULTS Eighteen articles (4178 patients) were included. The average age of the children was 2.26 (±0.75) years, and 65% (±5.64%) of them were boys. Cough was the most prevalent symptom upon presentation. The pooled analysis showed that the sensitivity of chest CT scan in detecting a foreign body in children was 99% (95% confidence interval, CI [97, 100]; I2 = 72%, τ2 = 0.0065, p < .01). The false negative rate was 1.8% (95% CI [0.3, 2.7]; I2 = 72%, p < .01). The specificity of chest CT scan was 92% (95% CI [83, 98]; I2 = 83%, τ2 = 0.0437, p < .01). CONCLUSIONS Chest CT scan is a sensitive and specific test for the diagnosis of FBA in the pediatric population. Its use can help to reduce unnecessary rigid bronchoscopies, especially in patients with a low clinical suspicion of aspiration. It should not be a replacement for the gold standard bronchoscopy, particularly in cases where there is a clear history and symptoms suggestive of aspiration.
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Affiliation(s)
- Patrick El Khoury
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Mikhael Makhoul
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christopher El Hadi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christelle Haber
- Department of Radiology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Simon Rassi
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Yavuz S, Sherif A, Saif S, Alzamar A, Alawad D, Abdelwahab A, Nabawi MN, Amirrad M, Francis N. Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center. Cureus 2023; 15:e40888. [PMID: 37492847 PMCID: PMC10364458 DOI: 10.7759/cureus.40888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
Background Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and method This retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH. Results There were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%. Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. Conclusion Bronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.
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Affiliation(s)
- Sinan Yavuz
- Pediatrics/Pediatric Pulmonology, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Amal Sherif
- Pediatrics, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Safiya Saif
- Pediatrics/Pediatric Pulmonology, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Asma Alzamar
- Pediatrics, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Doaa Alawad
- Pediatrics, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Ahmed Abdelwahab
- Pediatrics, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Maged N Nabawi
- Pediatrics/Pediatric Intensive Care, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
| | - Maryam Amirrad
- Education, Uinversity of Ottawa, Ottawa, CAN
- Pediatrics, Royal College of Pediatrics & Child Health, London, GBR
- Pediatrics, Ajman University, Ajman, ARE
| | - Nader Francis
- Pediatrics/Pediatric Pulmonology, Al Qassimi Woman's and Children's Hospital, Sharjah, ARE
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S. P, RB NN, K. G, SR K, S. R. Difficult Bronchoscopy and Foreign Body Removal: Our Experience. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1764365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background Foreign body in the airway is the most life-threatening situation. Most foreign bodies present as acute emergency and can be removed by endoscopy/bronchoscopy, while a few causes complication of a retained foreign body which requires emergency tracheostomy to secure airway followed by foreign body removal.
Case Presentation We report our experience in the management of three children who required tracheostomy through which bronchoscope was introduced and foreign body removed. All patients with unrecognized retained foreign body presented with respiratory distress with desaturation. Imaging was suggestive of atelectasis. After foreign body removal patients recovered well and decannulated by day 5.Subglottis is the narrowest part of pediatric airway. As these foreign bodies were vegetative they are hygroscopic in nature and hence would not be able to remove the foreign body by bronchoscopic guidance. Hence, tracheostomy was done to provide access followed by bronchoscopic removal.
Conclusion Aspirated foreign body present challenges to the ear, nose, and throat surgeon. Newer techniques enable removal of foreign body easier. Tracheostomy combined with bronchoscopy can be a life-saving and easy to perform procedure which involves removal of foreign body at the same time.
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Affiliation(s)
- Prabakaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Namasivaya Navin RB
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Gowthame K.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Karthika SR
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Rajasekaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
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Azzi JL, Seo C, McInnis G, Urichuk M, Rabbani R, Rozovsky K, Leitao DJ. A systematic review and meta-analysis of computed tomography in the diagnosis of pediatric foreign body aspiration. Int J Pediatr Otorhinolaryngol 2023; 165:111429. [PMID: 36621123 DOI: 10.1016/j.ijporl.2022.111429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/05/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Rigid bronchoscopy remains the gold standard for the diagnosis of foreign body aspiration (FBA) despite high rates of negative bronchoscopies. The use of computed tomography (CT) imaging in the assessment of FBA has recently emerged and could help obviate unnecessary bronchoscopy in these patients. The aim of this study is to assess the diagnostic accuracy of CT in the diagnosis of pediatric FBA. METHODS A systematic literature review was conducted to identify studies reporting the use of CT imaging in suspected pediatric FBA. The search included published articles in Ovid MEDLINE, Ovid EMBASE, PubMed MEDLINE and Web of Science. The search strategy included all articles from inception of the database to January 2021. Manuscripts were reviewed and graded for quality using the QUADAS-2 tool. Subgroup analyses based on the use of virtual bronchoscopy (VB) and sedation was conducted. A meta-analysis evaluating the use of VB in the diagnosis of FBA was also conducted. RESULTS Sixteen manuscripts met all inclusion criteria. In total, 2056 pediatric patients ranging from 0.3 to 15 years underwent CT for suspected FBA. The sensitivity and specificity of CT were 98.8% and 96.6%, respectively. VB was used in 71.4% (1391/1948) of patients while sedation during CT was required in 70.2% (1263/1800) of patients. Radiation dosing ranged from 0.04 to 2 mSv, 0.99-59.1 mGy-cm and 0.03-16.99 mGy. CONCLUSION CT can accurately diagnose pediatric FBA and can help decrease the rate of unnecessary bronchoscopies with an acceptable dose of radiation.
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Affiliation(s)
- Jayson Lee Azzi
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Chanhee Seo
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Graham McInnis
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Urichuk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rasheda Rabbani
- Department of George & Fay Yee Centre for Healthcare Innovation (CHI), University of Manitoba, Winnipeg, MB, Canada
| | - Katya Rozovsky
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Darren J Leitao
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada.
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5
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Shao H, Li S, He J, Wu L, Chen Z. A combination of flexible and rigid bronchoscopy in the successful removal of a residual fish bone from a peripheral bronchus: A case report. Front Pediatr 2023; 11:1114043. [PMID: 36896398 PMCID: PMC9989009 DOI: 10.3389/fped.2023.1114043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Although rigid bronchoscopy remains the gold standard for the management of foreign body (FB) inhalation, sometimes it still misses residual FBs. Inhalation of sharp FBs by infants is an uncommon but hazardous occurrence, which presents a significant challenge and demands expertise in therapeutic bronchoscopy. Particularly, residual sharp FBs in the peripheral tracheobronchial tree may pose challenging management problems for bronchoscopists. Herein, we describe the case of 1-year-old girl, who presented with persistent atelectasis in the left lower lobe for 20 days without responding to antibiotic therapy after removal of fish bone by rigid bronchoscopy at local hospital. Flexible bronchoscopy at our department showed a residual fish bone in the outer basal segment of the left lower lobe. A combined flexible and rigid bronchoscopy was then applied, and a fish bone measuring 1.5 cm in length was extracted on multiple attempts without any complications. Thus, our reports demonstrated that removal of challenging residual sharp FBs in the distal airways is possible with the aid of combined flexible and rigid bronchoscopy by an experienced multidisciplinary team. Additionally, a physician should pay special attention to abnormal chest images after removal of FBs.
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Affiliation(s)
- Hanqing Shao
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuxian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jing He
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Pietraś A, Markiewicz M, Mielnik-Niedzielska G. Rigid Bronchoscopy in Foreign Body Aspiration Diagnosis and Treatment in Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1206. [PMID: 34943402 PMCID: PMC8700144 DOI: 10.3390/children8121206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
Foreign body aspiration in children is a common condition and can bring about serious undesired results. Fast and accurate diagnosis and foreign body extraction from airways are essential. We performed a retrospective study on rigid bronchoscopy outcomes due to suspected foreign body aspiration. A total of 66 children were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin between 2015 and 2020 and underwent rigid bronchoscopy in general anesthesia due to suspected foreign body aspiration. We analyzed the data, including patients age and sex, reported complaints, and bronchoscopy findings. Analyzed children were aged from 8 months to 17 years old; 74.24% of them were under 3 years old during the procedure, and most of the operated patients were males. In 36.36% cases, no foreign body was identified, and 57.14% foreign bodies were located in right main bronchus. A total of 80.95% of foreign bodies extracted from airways were organic, mostly nuts. Diagnosis and treatment of suspected foreign body aspiration requires consistent cooperation between pediatricians, pulmonologists, anesthesiologists, and otolaryngologists.
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Affiliation(s)
- Aleksandra Pietraś
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland; (M.M.); (G.M.-N.)
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7
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Sekioka A, Koyama M, Fukumoto K, Nomura A, Urushihara N. Subtle Crucial X-Ray Findings in Pediatric Foreign Body Aspiration. Cureus 2021; 13:e14898. [PMID: 34109085 PMCID: PMC8182727 DOI: 10.7759/cureus.14898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Foreign body aspiration (FBA), with potentially life-threatening outcomes, is not unusual in the pediatric population. We report two cases of lobar bronchial radiolucent foreign bodies. Chest X-ray (CXR) showed a slight but significant finding of lobar emphysema without a significant mediastinal shift. This is possibly a key to suspecting foreign bodies. In the clinical field, a stepwise approach to detecting foreign bodies is commonly performed, from less invasive options such as CXR to computed tomography (CT). In this context, clinicians should scrupulously check CXRs when pediatric patients complain of respiratory symptoms, especially with potential FBA history.
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Affiliation(s)
- Akinori Sekioka
- Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, JPN
| | | | - Koji Fukumoto
- Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, JPN
| | - Akiyoshi Nomura
- Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, JPN
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8
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Francom CR, Javia LR, Wolter NE, Lee GS, Wine T, Morrissey T, Papsin BC, Peyton JM, Matava CT, Volk MS, Prager JD, Propst EJ. Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes. Int J Pediatr Otorhinolaryngol 2020; 134:110059. [PMID: 32339971 PMCID: PMC7172675 DOI: 10.1016/j.ijporl.2020.110059] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 01/25/2023]
Abstract
Aerosolization procedures during the COVID-19 pandemic place all operating room personnel at risk for exposure. We offer detailed perioperative management strategies and present a specific protocol designed to improve safety during pediatric laryngoscopy and bronchoscopy. Several methods of using disposable drapes for various procedures are described, with the goal of constructing a tent around the patient to decrease widespread contamination of dispersed droplets and generated aerosol. The concepts presented herein are translatable to future situations where aerosol generating procedures increase risk for any pathogenic exposure. This protocol is a collaborative effort based on knowledge gleaned from clinical and simulation experience from Children's Hospital Colorado, Children's Hospital of Philadelphia, The Hospital for Sick Children in Toronto, and Boston Children's Hospital.
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Affiliation(s)
- Christian R. Francom
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA,Corresponding author. Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 455, Aurora, CO, 80045, USA.
| | - Luv R. Javia
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nikolaus E. Wolter
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Gi Soo Lee
- Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Todd Wine
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Tyler Morrissey
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Blake C. Papsin
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - James M. Peyton
- Department of Anesthesiology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Mark S. Volk
- Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Jeremy D. Prager
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Evan J. Propst
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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9
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Stafler P, Nachalon Y, Stern Y, Leshno M, Mei Zahav M, Prais D, Kadmon G. Validation of a computerized scoring system for foreign body aspiration: An observational study. Pediatr Pulmonol 2020; 55:690-696. [PMID: 31909897 DOI: 10.1002/ppul.24632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/27/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision-making. In the present study, we aimed to validate it on a further cohort. STUDY DESIGN In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re-evaluation and bronchoscopy, if respiratory symptoms persisted. RESULTS Thirty-five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty-five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re-evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively. CONCLUSION The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision-making with regard to the need for bronchoscopy in children presenting to the emergency room.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Nachalon
- Ear, Nose, and Throat Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yoram Stern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ear, Nose, and Throat Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Moshe Leshno
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kadmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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10
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Reid A, Hinton-Bayre A, Vijayasekaran S, Herbert H. Ten years of paediatric airway foreign bodies in Western Australia. Int J Pediatr Otorhinolaryngol 2020; 129:109760. [PMID: 31751807 DOI: 10.1016/j.ijporl.2019.109760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whenever a paediatric airway foreign body (PAFB) is suspected, decisions may be difficult without a clearly defined or accepted treatment algorithm. History and examination are commonly non-diagnostic and the risks associated with either watchful waiting or proceeding to MLB are significant. This paper reviews a 10 year cohort of suspected PAFBs for the predictive utility of history, examination and investigations and subsequent positive findings at MLB. OBJECTIVES STUDY DESIGN: The medical records of 127 children who underwent MLB for suspected PAFB between 2007 and 2016 were examined. The data was retrospectively reviewed for epidemiological details, history, examination, radiological findings and MLB outcomes. RESULTS Sensitivity for PAFB on MLB with all three; history, examination and imaging (x-ray) positive for PAFB was 87.7%. Of the patients who were both symptom and sign positive (n = 96), chest x-ray findings did not significantly alter the chance of finding a PAFB. Chest x-ray had a low specificity (17%) in symptom and sign positive patients. Conversely, sensitivity of chest x-ray was high (88%), for symptom and sign positive patients. CONCLUSIONS For a child with both signs and symptoms, xray is unlikely to assist in decision making around suspected PAFB. When only sign or symptom is present, positive imaging may significantly increase the chance that PAFB is the cause.For patients with a low suspicion of PAFB, consideration of a CT can be a helpful means of excluding a PAFB and avoiding an unnecessary general anaesthetic in this potentially high-risk group.A greater level of public awareness is needed with regards to appropriate food types for children and the importance of eating seated and supervised in order to reduce the risk of PAFB.
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Affiliation(s)
- Allison Reid
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
| | - Anton Hinton-Bayre
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Shyan Vijayasekaran
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Hayley Herbert
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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11
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The Utility of Endoscope-Assisted Rigid Bronchoscopy in Pediatric Airway Foreign Body Removals. J Craniofac Surg 2019; 31:e217-e219. [PMID: 31188250 DOI: 10.1097/scs.0000000000005660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aspiration of foreign bodies is an emergency condition in children and may result in death, especially in children under 3 years of age. Therefore, diagnosis and treatment must be made rapidly. OBJECTIVE This study sought to summarize our experience with endoscope-assisted rigid bronchoscopy (RB) in the diagnosis and treatment of pediatric tracheobronchial foreign body emergencies to reduce complications and mortality. METHODS This was a retrospective cross-sectional study. The medical records of 337 children diagnosed with clinically suspected airway foreign body aspiration in the pediatric emergency department were analyzed retrospectively. The patients were divided into 2 groups with endoscopy used during RB in group 1 whereas group 2 was RB only. The surgeons who performed the bronchoscopies completed a survey on the advantages/disadvantages of these 2 procedures. RESULTS All of the patients had a positive history of suspected foreign body aspiration and foreign bodies were identified in 77.1% of the patients during RB. There were 161 (47.8%) patients in group 1 and 176 (52.2%) patients in group 2. In group 2, 5 patients showed transient hypoxia, and 6 patients had an episode of transient bleeding during the operations. These numbers were 3 and 3, respectively, in group 1. One patient in group 2 suffered cardiac arrest and died during surgery. The authors did not see any long-term complications after these operations and the authors did not find any statistically significant differences between the groups for complication rates. CONCLUSION The RB is the gold standard procedure for removal of pediatric airway foreign bodies. The survey used in this study and our extensive experience have shown that the distal bronchi and foreign bodies can be visualized more effectively when using a rigid endoscope during RB, especially in children under the age of 3 years. In order to improve the safety of the surgical procedure, the authors propose that endoscope-assisted RB should be used in emergencies concerning foreign bodies in the airways of children.
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12
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Tan GX, Boss EF, Rhee DS. Bronchoscopy for Pediatric Airway Foreign Body: Thirty-Day Adverse Outcomes in the ACS NSQIP-P. Otolaryngol Head Neck Surg 2018; 160:326-331. [PMID: 30226798 DOI: 10.1177/0194599818800470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) Describe outcomes of bronchoscopy with foreign body removal among children on the basis of a large standardized multi-institutional data set. (2) Identify factors associated with 30-day adverse events. STUDY DESIGN Cross-sectional analysis of a US national database. SETTING Public data set from the ACS NSQIP-P (American College of Surgeons National Surgical Quality Improvement Program-Pediatric) from 2012 to 2015. SUBJECTS AND METHODS Children <18 years old who underwent bronchoscopy with removal of foreign body were identified. Patient demographics, comorbidities, hospitalization factors, surgical characteristics, and 30-day postoperative adverse events, including complication and readmission, were analyzed. Multivariate logistic regression identified predictive factors for postoperative complications and prolonged length of stay. RESULTS A total of 275 children underwent bronchoscopic foreign body removal (n = 165 male, 60%; n = 75 nonwhite and/or Hispanic, 27%; mean age, 3.5 years [range, 0.63-17.9; median, 2.0]). Adverse events occurred among 10 children (4%). Seven had pulmonary-related complications, and 1 patient died. Three patients were readmitted; there were no reoperations. On multivariate analysis, preoperative pulmonary disease or need for pulmonary support (odds ratio [OR], 6.42; P = .04) predicted postoperative complications. Preoperative pulmonary compromise (OR, 8.10; P < .01), American Society of Anesthesiologists class 3 or 4 (OR, 4.13; P < .01), and prolonged operative time (OR, 3.05; P = .01) were associated with prolonged hospital stay. CONCLUSION Bronchoscopy for retrieval of foreign body among children has an overall low incidence of 30-day adverse events. Children with preoperative pulmonary compromise have a significantly higher risk of postoperative complications. These findings may be applied to optimize perioperative care and counsel parents and families.
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Affiliation(s)
- Grace X Tan
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily F Boss
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel S Rhee
- 2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Noh KB, Salim R, Abdullah MS, Mohamad I. Metallic hair pin aspiration into the left tertiary bronchus. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2018; 13:36-38. [PMID: 30302183 PMCID: PMC6173961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.
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Affiliation(s)
- K B Noh
- Department of Otorhinolaryngology - Head & Neck Surgery School of Medical Sciences Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia.
| | - R Salim
- Department of Otorhinolaryngology-Head & Neck Surgery School of Medical Sciences Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia
| | - M S Abdullah
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kota Bharu, Kelantan Malaysia
| | - I Mohamad
- School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kota Bharu Kelantan, Malaysia
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14
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Ahmed OG, Guillerman RP, Giannoni CM. Protocol incorporating airway CT decreases negative bronchoscopy rates for suspected foreign bodies in pediatric patients. Int J Pediatr Otorhinolaryngol 2018; 109:133-137. [PMID: 29728167 DOI: 10.1016/j.ijporl.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Foreign body aspiration (FBA) is the 4th leading cause of death in children between the ages 1-5. Although direct laryngoscopy and bronchoscopy (DL&B) is the reference standard for diagnosis of pediatric airway foreign bodies, there is a high negative bronchoscopy rate, exposing patients to unnecessary operative and anesthetic risks and costs. METHODS A clinical care protocol entailing the selective use of low-dose non-contrast airway computed tomography (CT) for children with an intermediate risk for FBA on the basis of clinical exam and chest radiography was implemented to decrease the negative DL&B rate. A retrospective review was conducted to compare negative bronchoscopy rates before and after implementation of the new protocol and the diagnostic performance characteristics of airway CT for airway foreign bodies were analyzed. RESULTS After implementation of the airway FB clinical care protocol entailing selective airway CT, the overall negative bronchoscopy rate decreased from an institutional historical rate of 37% (54/145) to 17% (10/56) (p = .06). The overall sensitivity, specificity, and positive and negative predictive value of airway CT for FB was 91%, 100%, 100%, and 97% respectively. CONCLUSIONS Low-dose non-contrast airway CT is highly sensitive and specific for airway foreign bodies, and its selective use in a clinical care protocol for children with suspected foreign body aspiration could greatly reduce the negative bronchoscopy rate, thereby decreasing operative risks and costs.
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Affiliation(s)
- Omar G Ahmed
- Texas Children's Hospital, Otolaryngology, Houston, TEXAS, USA; Baylor College of Medicine, Otolaryngology, Houston, TEXAS, USA.
| | - Robert P Guillerman
- Texas Children's Hospital, Department of Pediatric Radiology, Houston, TX, USA; Baylor College of Medicine, Department of Radiology, Houston, TX, USA
| | - Carla M Giannoni
- Texas Children's Hospital, Otolaryngology, Houston, TEXAS, USA; Baylor College of Medicine, Otolaryngology, Houston, TEXAS, USA
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Pitiot V, Grall M, Ploin D, Truy E, Ayari Khalfallah S. The use of CT-scan in foreign body aspiration in children: A 6 years' experience. Int J Pediatr Otorhinolaryngol 2017; 102:169-173. [PMID: 29106868 DOI: 10.1016/j.ijporl.2017.08.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 01/07/2023]
Abstract
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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Affiliation(s)
- Vincent Pitiot
- Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France; Claude Bernard Lyon1 University, Lyon, Rhone, France.
| | - Margaux Grall
- Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France; Claude Bernard Lyon1 University, Lyon, Rhone, France
| | - Dominique Ploin
- Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France
| | - Eric Truy
- Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France; Claude Bernard Lyon1 University, Lyon, Rhone, France
| | - Sonia Ayari Khalfallah
- Hôpital Femme Mère Enfant - Hospices Civils De Lyon, Oto-Rhino-Laryngology and Cervico Facial Surgery, Lyon, Rhone, France; Claude Bernard Lyon1 University, Lyon, Rhone, France
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16
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Isaiah A, Pereira KD. Laryngotracheal anomalies and airway fluoroscopy in infants. Int J Pediatr Otorhinolaryngol 2017; 97:109-112. [PMID: 28483219 DOI: 10.1016/j.ijporl.2017.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/17/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The role of airway fluoroscopy in the diagnosis of laryngotracheal anomalies in infants is controversial. We aimed to (i) compare airway fluoroscopic characteristics with endoscopic findings in infants presenting for evaluation of upper airway obstruction and (ii) assess the as low as is reasonably achievable (ALARA) status for airway fluoroscopy as an initial diagnostic test in suspected laryngotracheal anomalies. MATERIALS AND METHODS We performed a retrospective review of children who underwent fluoroscopy and endoscopic evaluation of the airway in the operating room for suspected laryngotracheal anatomic abnormalities. Thirty-four infants who underwent both procedures at a tertiary level university-based children's hospital from January 1, 2008 to December 1, 2013 were included. Infants with suspected foreign bodies or an existing tracheostomy were excluded. Intraoperative findings from endoscopy and radiologic interpretation from fluoroscopy were compared using standard tools for validation of a diagnostic test. These metrics were compared with historic data that suggested good correlation between radiologic and endoscopic findings in older children. RESULTS The median age was 3.6 months (range 1-8 months). The sensitivity of airway fluoroscopy for determining laryngotracheal pathology was 18%. Specificity, positive predictive value and negative predictive value were 83%, 67% and 35%, respectively. Although each fluoroscopic exposure was optimized for pediatric patients, the median cumulative exposure to ionizing radiation was 19 mR (range 10-34 mR). CONCLUSIONS Airway fluoroscopy yields metrics that are overall poor to be considered a valid and accurate universal radiologic diagnostic test in infants evaluated for laryngotracheal pathology. The cumulative exposure to ionizing radiation from use of a fluoroscope cannot be justified by the sensitivity of the test and may not conform to ALARA standards for imaging in this population.
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Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, United States.
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Kostic G, Petrovic M, Markovic S, Knezevic J, Igrutinovic Z, Medovic R, Raskovic Z, Stankovic L, Minic P. Application of the Virtual Bronchoscopy in Children with Suspected Aspiration of the Foreign Body - Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In diagnosing the aspiration of the foreign body (AFB) in children most important are: medical history, clinical signs and positive radiography of the lungs. Common dilemmas in the diff erential diagnosis are life-threatening asthma attacks or difficult pneumonia. Conventional rigid bronchoscopy (RB) is not recommended as a routine method. Virtual bronchoscopy (VB) can be a diagnostic tool for solving dilemmas. Fiber-optic bronchoscopy (FOB) has a therapeutic stake in severe cases. Herein, we describe a girl, at the age of 6, who was hospitalized due to rapid bronchoconstriction and based on the anamnesis, clinical symptoms and physical fi ndings the suspicion was that she aspirated the foreign body. Due to the poor general condition and possible sequel, the idea of RB was dropped out. Multidetector computed tomography of the chest and VB was performed and AFB was not found. Due to positive epidemiological situation, virus H1N1 was excluded. FOB established that the foreign body does not exist in the airways. During bronchoscopy numerous castings are aspirated from the peripheral airways which lead to faster final recovery. With additional procedures, the diagnosis of asthma was confirmed and for girl that was the first attack. Along with inhaled corticosteroids as prevention she feels well.
Virtual bronchoscopy can be successfully used as a valid diagnostic procedure in suspected foreign body in the children’s lungs, but fiber-optic bronchoscopy remains most important diagnostic and therapeutic method.
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Affiliation(s)
- Gordana Kostic
- Clinic for Pediatrics, Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Center for Pulmonary Diseases, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Slavica Markovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jasmina Knezevic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zoran Igrutinovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Rasa Medovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Zorica Raskovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Lidija Stankovic
- Clinic for Pediatrics, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Predrag Minic
- Institute for health protection of mother and child of Serbia “dr Vukan Cupic”, Belgrade, Serbia
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Paradis TJ, Dixon J, Tieu BH. The role of bronchoscopy in the diagnosis of airway disease. J Thorac Dis 2016; 8:3826-3837. [PMID: 28149583 DOI: 10.21037/jtd.2016.12.68] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopy of the airway is a valuable tool for the evaluation and management of airway disease. It can be used to evaluate many different bronchopulmonary diseases including airway foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage. Traditionally, options for evaluation were limited to flexible and rigid bronchoscopy. Recently, more sophisticated technology has led to the development of endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB). These technological advances, combined with increasing provider experience have resulted in a higher diagnostic yield with endoscopic biopsies. This review will focus on the role of bronchoscopy, including EBUS, ENB, and rigid bronchoscopy in the diagnosis of bronchopulmonary diseases. In addition, it will cover the anesthetic considerations, equipment, diagnostic yield, and potential complications.
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Affiliation(s)
- Tyler J Paradis
- Department of Anesthesiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jennifer Dixon
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Brandon H Tieu
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Kazachkov M, Vicencio A. Foreign body removal is getting "cooler". Pediatr Pulmonol 2016; 51:886-8. [PMID: 27378166 DOI: 10.1002/ppul.23521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/19/2016] [Accepted: 06/03/2016] [Indexed: 12/17/2022]
Abstract
Foreign body removal is commonly performed with the rigid bronchoscope. However, based on recent literature, extraction with the flexible bronchoscope has increased in popularity. Here, we discuss a new tool - the flexible cryoprobe - that may enhance foreign body retrieval in select patients and comment on the methods of foreign body extraction in the view of common clinical practice. Pediatr Pulmonol. 2016; 51:886-888. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mikhail Kazachkov
- Division of Pediatric Pulmonology, NYU Department of Pediatrics, 160, East 32nd Street FINK CENTER, New York 10016, New York
| | - Alfin Vicencio
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Beth Israel, New York, New York
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Zhang L, Yin Y, Zhang J, Zhang H. Removal of foreign bodies in children's airways using flexible bronchoscopic CO2 cryotherapy. Pediatr Pulmonol 2016; 51:943-9. [PMID: 26969845 DOI: 10.1002/ppul.23361] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/08/2015] [Accepted: 10/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present retrospective study investigated the safety and efficacy of removing foreign bodies from children's airways using flexible bronchoscopic CO2 cryotherapy instead of traditional foreign body aspiration. METHODS Between October 2012 and June 2014 in the Shanghai Children's Medical Center, we performed flexible bronchoscopic CO2 cryotherapy to remove foreign bodies from the airways of 12 children who ranged in age from 10 to 40 months and analyzed outcomes and complications. RESULTS Using cryotherapy, we successfully and without complications removed the foreign bodies in eight of 12 children. In two cases, the foreign bodies were removed successfully, but cryotherapy partially damaged the airway mucosa, which caused partial airway obstruction because of the newly developed granulation tissue. We incompletely removed the foreign body in one case and failed to remove the foreign body in another case. No serious adverse reactions or complications were observed after the treatments. CONCLUSION Removal of foreign bodies from children's airways using flexible bronchoscopic CO2 cryotherapy may be a safe, easy, and effective method. Pediatr Pulmonol. 2016; 51:943-949. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lei Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong Yin
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Zhang
- Department of Pneumology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Acharya K. Rigid Bronchoscopy in Airway Foreign Bodies: Value of the Clinical and Radiological Signs. Int Arch Otorhinolaryngol 2016; 20:196-201. [PMID: 27413398 PMCID: PMC4942294 DOI: 10.1055/s-0036-1584293] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/01/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction
Foreign body in airway is a common emergency in ENT practice. As we know, Rigid Bronchoscopy is the method of choice for removing it, although at times it leads to specialists performing unnecessary bronchoscopy, exposing patients to hazards of general anesthesia. Objective
The objective of my study is to calculate sensitivity, specificity, positive predictive value, odds ratio from the clinical and radiological signs, comparing with the gold standard, the rigid bronchoscope procedure. Method
This is a prospective analytical study designed at University Teaching Hospital and conducted over a period of 18 months, from March 2011 to August 2012. Data collection was broadly classified into three different categories: (1) Symptomatology, such as presence or absence of choking, cyanosis, and difficulty in breathing; (2) Clinical signs, such as the presence or absence of air entry, crackles, and rhonchi 3. Chest X-ray findings were suggestive of a foreign body. Results
There were a total of 40 rigid bronchoscopies performed under general anesthesia for the diagnosis and therapeutic reasons. Among 40 patients who underwent rigid bronchoscopy, 32 (80%) were found to have varieties of foreign bodies in their airway while 8 patients (20%) had negative bronchoscopy. The history of choking is the only clinical symptoms which came out to be statistically Significant (p = 0.043) with odds ratio of 5. Conclusion
Rigid bronchoscopy is the gold standard technique for diagnosis and procedure of choice to remove FB from airway. Regardless, it still presents a small chance of negative result, especially when there is no history of aspiration.
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Affiliation(s)
- Kunjan Acharya
- Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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22
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Friedman EM, Anthony B. A Five-Year Analysis of Airway Foreign Body Management. Ann Otol Rhinol Laryngol 2016; 125:591-5. [DOI: 10.1177/0003489416637387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To identify characteristics in patients who undergo positive and negative bronchoscopy for a suspected airway foreign body (AFB). Methods: Review medical records between 2008 and 2012. Results: There were 145 patients who went to the operating room with the pre-bronchoscopy diagnosis of suspected AFB during the study period. There was an overall negative bronchoscopy rate of an average of 37%, with an annual range between 21% and 50%. The findings of history or suspicion of choking, asymmetric breath sounds, and wheezing were statistically more common in patients with an AFB. Chest roentograms (CXR) had a sensitivity and specificity of 62% and 57%. Twenty patients had a chest computed tomography (CT) scan, and 100% were clinically significant. Four CT scans were diagnostic of an AFB, and 16 patients avoided bronchoscopy after negative CT. Conclusions: In current clinical practice, it is difficult to identify patients with an AFB without performing bronchoscopy. This results in a significant number of negative bronchoscopes. Certain elements in the history and physical exam were more common in patients who were found to have an AFB. Our preliminary data suggest that chest CT scans may be useful to decrease the number of negative bronchoscopies.
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Affiliation(s)
- Ellen M. Friedman
- Baylor College of Medicine and Texas Children’s Hospital, Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Houston, Texas, USA
| | - Benjamin Anthony
- Laryngology Fellow, The Emory University School of Medicine, Atlanta, Georgia, USA
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Barneck MD, Webb JT, Robinson RE, Grimmer JF. Flow dynamics in pediatric rigid bronchoscopes using computer-aided design modeling software. Laryngoscope 2015; 126:1940-5. [DOI: 10.1002/lary.25690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/08/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - J. Taylor Webb
- Department of Bioengineering; University of Utah; Salt Lake City Utah U.S.A
| | - Ryan E. Robinson
- Department of Bioengineering; University of Utah; Salt Lake City Utah U.S.A
| | - J. Fredrik Grimmer
- Division of Otolaryngology; University of Utah; Salt Lake City Utah U.S.A
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Reducing the number of rigid bronchoscopies performed in suspected foreign body aspiration cases via the use of chest computed tomography: is it safe? A literature review. The Journal of Laryngology & Otology 2014; 129 Suppl 1:S1-7. [PMID: 25402832 DOI: 10.1017/s0022215114002862] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Foreign body aspiration is common and potentially life threatening. Although rigid bronchoscopy has the potential for serious complications, it is the 'gold standard' of diagnosis. It is used frequently in light of the inaccuracy of clinical examination and chest radiography. Computed tomography is proposed as a non-invasive alternative to rigid bronchoscopy. OBJECTIVE This study aimed to evaluate the accuracy and safety of computed tomography used in the diagnosis of suspected foreign body aspiration, and compare this with the current gold standard, in order to examine the possibility of using computed tomography to reduce the number of diagnostic rigid bronchoscopies performed. METHOD The study comprised a review of literature published from 1970 to 2013, using the PubMed, Scopus, Web of Knowledge, Embase and Medline electronic databases. RESULTS The sensitivity for computed tomography ranged between 90 and 100 per cent, with four studies demonstrating 100 per cent sensitivity. Specificity was between 75 and 100 per cent. Radiation exposure doses averaged 2.16 mSv. CONCLUSION Computed tomography is a sensitive and specific modality in the diagnosis of foreign body aspiration, and its future use will reduce the number of unnecessary rigid bronchoscopies.
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25
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A violent cough in a 6-year-old boy. JAAPA 2014; 27:52-3. [PMID: 25343436 DOI: 10.1097/01.jaa.0000455654.42543.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diagnosis of paediatric airway foreign body: is it easy? Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractForeign-body aspiration in children results in diagnostic problems, mainly because of nonspecific signs. Therefore, in this study, we placed particular stress on false-positive and -negative predictors. Charts of 139 consecutive paediatric patients aged 6.0 months to 15.5 years who underwent bronchoscopy for a suspected foreign body aspiration were analysed retrospectively. A foreign body was found in 95 cases (68%). The anamnesis was positive in 91%. Cough was the most common clinical symptom (91%) with a sensitivity and specificity of 94% and 23%, respectively. There were no significant correlations between clinical symptoms and the locations of foreign bodies. The majority of focal hyperinflation (24%) and atelectasis (15%) were seen in chest radiographs, with a sensitivity and specificity of 33% and 89% (hyperinflation) and 15% and 82% (atelectasis), respectively. Chest X-rays were normal in 46 cases; however, an object was removed in 25. Persistent infiltrates were present in 14 X-rays, and a foreign body was extracted during bronchoscopy in 4. A highly significant correlation between the type of foreign body and radiological signs was noted (p = 0.00001). Anamnesis, clinical symptoms, and radiological findings are helpful in confirming aspiration, but can be misleading. Chronic or recurrent pneumonia should prompt further bronchoscopic diagnosis.
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Abstract
Bronchogenic cysts (BCs) can be life threatening if they compress vital structures in infants and small children. In particular, subcarinal cysts can be life-threatening and compromise the airways. In infants, the initial presentation may be respiratory distress. We report a case of mediastinal cystic mass compressing the main left bronchus. The case was an 18-month-old boy who had been admitted with acute respiratory distress. Chest x-ray showed overdistension of the left lung and a mediastinal shift. Foreign body aspiration was diagnosed. Magnetic resonance imaging was performed, which has shown a mediastinal cystic mass; therefore, the patient underwent thoracotomy. Surgical intervention revealed a subcarinal extrapulmonary BC that compresses the left main bronchus. The diagnosis of BC was confirmed with pathological investigation. In this report, we present a case of BC with the emphasis on the differential diagnosis with foreign body aspiration.
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Manach Y, Pierrot S, Couloigner V, Ayari-Khalfallah S, Nicollas R, Venail F, Pondaven S, Baculard F, Tantcheu V. Diagnostic performance of multidetector computed tomography for foreign body aspiration in children. Int J Pediatr Otorhinolaryngol 2013; 77:808-12. [PMID: 23489882 DOI: 10.1016/j.ijporl.2013.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the sensitivity of multidetector computed tomography for confirming suspected foreign body aspiration into the airways in children. METHOD We conducted a multicentre prospective study of 303 children evaluated using multidetector computed tomography with axial analysis complemented by multiplanar reconstruction when required. The images were read by a radiologist before endoscopy then reviewed later by a senior radiologist blinded to the endoscopy findings. Endoscopy was performed routinely. RESULTS Foreign bodies were found by endoscopy in 70 of the 303 children. The initial multidetector computed tomography reading was 94% sensitive and 95% specific. For the review, the images for 91 patients were excluded because of motion blurring or absence of larynx visualisation; in the remaining 212 patients, sensitivity was 98% and specificity 97%. CONCLUSION Multidetector computed tomography as performed in our patients cannot replace endoscopy, which remains the reference standard. Nevertheless, multidetector computed tomography is sufficiently sensitive to be of value when foreign body aspiration is not considered initially or when endoscopy is likely to prove challenging.
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Affiliation(s)
- Yves Manach
- APHP, Necker-Enfants Malades Hospital, Paediatric ENT Department, 75015 Paris, France.
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