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Mowat A, Balbirsingh V, Sandhar P, Parekh M, Amlani A, Young B, Giblett N. Rigid bronchoscopy: a consultant survey. Ann R Coll Surg Engl 2024; 106:377-384. [PMID: 37843132 PMCID: PMC10981987 DOI: 10.1308/rcsann.2023.0067] [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] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid bronchoscopy represents the gold standard to diagnose and retrieve paediatric foreign bodies. Cases are encountered infrequently, creating anxieties about their management. Little is known about the confidence in, and maintenance of, rigid bronchoscopy skills by ear, nose and throat teams. METHODS A 15-question survey was completed by 50 practising otolaryngology consultants in England. RESULTS Results show that almost 40% of otolaryngology consultants covering rigid bronchoscopy have not performed bronchoscopy in more than 5 years. Consultants raised concerns about the anaesthetic support and the speed of equipment assembly. Questions on clinical practice showed disparities in practice in the same scenario. CONCLUSIONS The authors advocate addressing many of the issues raised by the study with a greater availability of simulation courses and regular scheduled intradepartmental teaching days for all professionals involved. National guidelines on criteria for transfer to tertiary centres would improve the consistency of practice.
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Affiliation(s)
- A Mowat
- The Royal Wolverhampton NHS Trust, UK
| | | | - P Sandhar
- The Royal Wolverhampton NHS Trust, UK
| | - M Parekh
- The Royal Wolverhampton NHS Trust, UK
| | - A Amlani
- The Royal Wolverhampton NHS Trust, UK
| | - B Young
- Maidstone and Tunbridge Wells NHS Trust, UK
| | - N Giblett
- The Royal Wolverhampton NHS Trust, UK
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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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Wang ML, Png LH, Ma J, Lin K, Sun MH, Chen YJ, Tang XC, Bi XY, Gao YQ, Zhang TS. The Role of CT Scan in Pediatric Airway Foreign Bodies. Int J Gen Med 2023; 16:547-555. [PMID: 36814890 PMCID: PMC9939907 DOI: 10.2147/ijgm.s398727] [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] [Received: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Objective We aim to determine the utility of CT scan as a method to accurately confirm pediatric airway foreign bodies (AFBs), the current gold standard of which is chest X-ray as the primary imaging modality in the investigation screening of AFBs with progression to microlaryngobronchoscopy. Methods A retrospective cohort study of children diagnosed with suspected AFBs between July 2019 and June 2020 was conducted. The primary outcome of missed AFBs from radiologic investigations was recorded. Results A total of 226 children with an average age of 1.94 years were included in this study. One hundred and two children were eventually admitted to the hospital for microlaryngobronchoscopy. A total of 89 cases were initially examined by chest X-ray with the diagnosis confirmed in 26 cases. The initial examination was chest CT scan in 105 cases, of which the diagnosis was confirmed in 46 cases. The initial examination was chest CT scan with airway reconstruction in 32 cases, and the diagnosis was confirmed in 17 cases. Patients with negative chest CT scan with airway reconstruction were observed to have resolution of symptoms with no further need for bronchoscopy. Conclusion Chest CT scan with airway reconstruction had the highest rate of confirmed diagnosis of pediatric AFBs on initial scanning, followed by chest CT scan, and finally chest X-ray with fluoroscopy; there was no missed diagnosis in chest CT scan with airway reconstruction. Chest CT scan with airway reconstruction can accurately and quickly detect AFBs and reduce unnecessary bronchoscopy.
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Affiliation(s)
- Mei-Lan Wang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Lu Hui Png
- Department of Otorhinolaryngology – Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore,Correspondence: Lu Hui Png; Tie-Song Zhang, Email ;
| | - Jing Ma
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Ken Lin
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Mei-hua Sun
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Yi-Jun Chen
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming Medical University, Kunming, People’s Republic of China
| | - Xian-Chao Tang
- Department of Radiology, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Xian-Yun Bi
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Ying-Qin Gao
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
| | - Tie-Song Zhang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children’s Hospital, Kunming, People’s Republic of China
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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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Yuan M, Xiao Y, Ni F, Yin W, Hu Y. Endobronchial removal of the peripherally located foreign body with the ultrathin bronchoscopy and ultrathin cryoprobe guided by a manual navigating method: A case report. Medicine (Baltimore) 2022; 101:e31903. [PMID: 36482649 PMCID: PMC9726376 DOI: 10.1097/md.0000000000031903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONAL The bronchoscope is a preferential method used to remove airway foreign bodies, but for those located in the distal lumen of bronchus with long-time retention, how to remove them remains an intractable problem. PATIENT CONCERNS A 57-year-old male presented with 2-week history of intermittent hemoptysis. Chest CT upon admission revealed a high-density opacity incarcerated in the distal basal segment of the left lower lobe, along with obstructive pneumonia. DIAGNOSES The patient was diagnosed as foreign body aspiration. INTERVENTIONS We firstly used a manual navigating method to draw a bronchoscopic map according to the thin-section CT. Then we adopted ultrathin bronchoscope (UTB) to remove the peripherally located foreign body. OUTCOMES UTB successfully found the foreign body incarcerated in LB10ciiβ under the guidance of manual navigation, but it was too tender to be extracted completely by forceps, and it was even pushed further away. Then 1.1 mm ultrathin cryoprobe was used, with an activation time of 4 seconds, the chili was frozen and completely removed. LESSONS This first combined application of manual navigating method, UTB and ultrathin cryoprobe, successfully extracted foreign bodies lodged in the distal airways and thus avoided thoracic surgery.
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Affiliation(s)
- Mingli Yuan
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Xiao
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Ni
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Yin
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Hu
- Department of Pulmonary and Critical Care Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yi Hu, Department of Respiratory Medicine, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Street, Jiang’an, Wuhan 430014, China (e-mail: )
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Sakamoto N, Fujii S, Masumoto K, Matsuoka A, Toumine S, Hara T, Shimada K. Plastic foreign body in the pharynx can evade detection by computed tomography. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gordon L, Nowik P, Mobini Kesheh S, Lidegran M, Diaz S. Diagnosis of foreign body aspiration with ultralow-dose CT using a tin filter: a comparison study. Emerg Radiol 2020; 27:399-404. [PMID: 32152760 PMCID: PMC7343722 DOI: 10.1007/s10140-020-01764-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/18/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Suspected airway foreign body aspiration (FBA) is a common event in paediatric emergency units, especially in children under 3 years of age. It can be a life-threatening event if not diagnosed promptly and accurately. The purpose of this study is to compare the diagnostic performance of an ultralow-dose CT (DLP of around 1 mGycm) with that of conventional radiographic methods (fluoroscopy and chest radiography of the airways) in the diagnosis of FBA children's airways. METHODS Retrospective cross-sectional study. Data from 136 children were collected: 75 were examined with conventional radiographic methods and 61 with ultralow-dose CT. Effective doses were compared using independent t tests. The results of bronchoscopy, if performed, were used in creating contingency 2 × 2 tables to assess the diagnostic performance between modalities. An extra triple reading of all images was applied for this purpose. RESULTS The effective doses used in the ultralow-dose CT examinations were lower compared with those in conventional methods (p < 0.001). The median dose for CT was 0.04 mSv compared with 0.1 mSv for conventional methods. Sensitivity and specificity were higher for ultralow-dose CT than those for conventional methods (100% and 98% versus 33% and 96%) as were the positive and negative predicted values (90% and 100% versus 60% and 91%). CONCLUSION Ultralow-dose CT can be used as the imaging of choice in the diagnosis of airway FBA in emergency settings, thereby avoiding concerns about radiation doses and negative bronchoscopy outcomes.
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Affiliation(s)
- Lena Gordon
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Nowik
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Shahla Mobini Kesheh
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marika Lidegran
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Diaz
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. .,Department of Diagnostic Radiology, Skane University Hospital, Malmo, Sweden.
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Huang H, Seif MM, Ren J, Shi H, Shen X, Wang Q, Yang J, Zhang Y, Ning Y, Yang Y, Zarogoulidis P, Tsakiridis K, Hohenforst-Schmidt W, Turner JF, Michael S, Li Q, Freitag L, Fyntanidou V, Kosmidis C, Romanidis K, Oikonomou P, Sapalidis K, Bai C. Endobronchial removal of the high-risk osseous foreign bodies with evaluation and planning by virtual navigation system. Respir Med Case Rep 2019; 28:100952. [PMID: 31709141 PMCID: PMC6831871 DOI: 10.1016/j.rmcr.2019.100952] [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] [Received: 09/07/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
We report herein on two cases where high-risk osseous foreign bodies that incarcerated or penetrated the bronchial wall. The foreign bodies were unable to be removed via flexible bronchoscope (FB), with the foreign bodies close to the pulmonary artery and aortic artery. After preoperative evaluation and planning with the virtual bronchoscopic navigation (VBN) system, the airway foreign bodies were extracted effectively and safely using advanced therapeutic endoscopic technique by rigid bronchoscope (RB), thus avoiding the surgical thoracotomy.
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Affiliation(s)
- Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Moaad Mohamed Seif
- Department of Pulmonology, Djiboutian Military Hospital, Djibouti City, Djibouti
| | - Jie Ren
- Department of Respiration, The First People's Hospital of Xinjiang, KashgarArea, Kashgar, Xinjiang, China
| | - Hui Shi
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaping Shen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Wang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Yang
- Department of Laboratory & Pathology, No. 905 Hospital, The Second Military Medical University, Shanghai, China
| | - Yuan Zhang
- Department of Ophthamology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yunye Ning
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yuguang Yang
- Department of Anesthesiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Paul Zarogoulidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Corresponding author. 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
| | - J. Francis Turner
- University of Tennessee Graduate School of Medicine, Department of Medicine, Knoxville, TN, USA
| | - Simoff Michael
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, Detroit, USA
| | - Qiang Li
- The Diagnostic and Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Varvara Fyntanidou
- Anesthesiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christoforos Kosmidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Sapalidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Corresponding author. Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China.
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Ullal A, Mundra RK, Gupta Y, Mishra S. Virtual Bronchoscopy: Highly Sensitive Time and Life Saving Investigation in the Diagnosis of Foreign Body Aspiration-Our Experience. Indian J Otolaryngol Head Neck Surg 2019; 71:378-383. [PMID: 31741990 PMCID: PMC6848534 DOI: 10.1007/s12070-018-1319-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 03/24/2018] [Indexed: 10/17/2022] Open
Abstract
Foreign body airway is a common cause of morbidity and mortality in children. Virtual bronchoscopy is a new investigative technique useful in locating non radiopaque FB missed on plain radiography. The aim of the study was to study the clinical profile of patients with suspected foreign body aspiration and to evaluate the changing trends in the diagnosis and quicker management of foreign body aspiration as a way of virtual bronchoscopy. This was a retrospective and prospective cross sectional study conducted in the Department of Otorhinolaryngology M.G.M.M.C. and M.Y. Hospital Indore for a period of 10 years. The medical records of patients with foreign body aspiration, from August 2006 to September 2016 were reviewed. Data was collected regarding their clinical presentation, examination and chest X-ray, virtual bronchoscopy, rigid bronchoscopy findings. Patients with suspected foreign body aspiration were subjected to virtual bronchoscopy and rigid bronchoscopy was performed. The techniques and methods to extract different types of foreign bodies has been elaborated in this study. In the 150 subjects, we observed mean age group of presentation was 2.1 years, male is to female ratio was 4.1, 70% of the cases came from the rural areas, 86% were vegetative foreign bodies, and remaining non vegetative were aspirated mostly during the winter season. Betel nut was the most common aspirated foreign body 0.63% had a positive history of foreign body aspiration, where as 37% had a negative history. Right main bronchus was the most common site of lodgement. Breathlessness and reduced air entry were the most common symptoms and signs. We also observed, that chest radiograph were normal in as many as 40% cases. Hence negative chest radiographs does not rule out FB. In 150 patients with foreign body aspiration, which was detected by virtual bronchoscopy, 148 patients were diagnosed to have foreign body on rigid bronchoscopy. This amounts to a positive predictive value of 97.3% which was similar to the positive predictive value of rigid bronchoscopy which was 99%. Virtual bronchoscopy is the only imaging modality which gives 99.9% reassurance about the presence or absence of a foreign body, because of its high sensitivity and specificity, hence proves to be a life saving tool.
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Affiliation(s)
- Aishwarya Ullal
- Department of Otorhinolaryngology and Head and Neck Surgery, MGMMC, Indore, India
| | - R. K. Mundra
- Department of Otorhinolaryngology and Head and Neck Surgery, MGMMC, Indore, India
| | - Yamini Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, MGMMC, Indore, India
| | - Sanjeev Mishra
- Department of Otorhinolaryngology and Head and Neck Surgery, MGMMC, Indore, India
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Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011-2018. Int J Pediatr Otorhinolaryngol 2019; 124:90-93. [PMID: 31174024 DOI: 10.1016/j.ijporl.2019.05.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy. METHODS The medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema. RESULTS Of the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7-156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups. CONCLUSIONS Foreign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.
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Gibson EA, Balsa IM, Mayhew PD, Phillips K, Giuffrida MA, Culp WTN, Steffey MA, Johnson LR. Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration. Vet Surg 2019; 48:1309-1317. [PMID: 31334873 DOI: 10.1111/vsu.13287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. STUDY DESIGN Retrospective case series. ANIMALS Thirty-seven client-owned dogs. METHODS Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. RESULTS At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty-six dogs had one or more lung lobes surgically removed. Thirty-seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty-five of 37 (94.6%) dogs survived to discharge. CONCLUSION Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short- and long-term survival was excellent in this cohort. CLINICAL SIGNIFICANCE Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.
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Affiliation(s)
- Erin A Gibson
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Ingrid M Balsa
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Kathryn Phillips
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - William T N Culp
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Science, University of California-Davis School of Veterinary Medicine, Davis, California
| | - Lynelle R Johnson
- Department of Medicine and Epidemiology, University of California-Davis School of Veterinary Medicine, Davis, California
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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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Su SC, Masters IB, Buntain H, Frawley K, Sarikwal A, Watson D, Ware F, Wuth J, Chang AB. A comparison of virtual bronchoscopy versus flexible bronchoscopy in the diagnosis of tracheobronchomalacia in children. Pediatr Pulmonol 2017; 52:480-486. [PMID: 27641078 DOI: 10.1002/ppul.23606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) is the current gold standard for diagnosing tracheobronchomalacia. However, it is not always feasible and virtual bronchoscopy (VB), acquired from chest multi-detector CT (MDCT) scan is an alternative diagnostic tool. We determined the sensitivity, specificity, and positive and negative predictive values of VB compared to FB in diagnosing tracheobronchomalacia. METHODS Children aged <18-years scheduled for FB and MDCT were recruited. FB and MDCT were undertaken within 30-min to 7-days of each other. Tracheobronchomalacia (mild, moderate, severe, very severe) diagnosed on FB were independently scored by two pediatric pulmonologists; VB was independently scored by two pairs (each pair = pediatric pulmonologist and radiologist), in a blinded manner. RESULTS In 53 children (median age = 2.5 years, range 0.8-14.3) evaluated for airway abnormalities, tracheomalacia was detected in 37 (70%) children at FB. Of these, VB detected tracheomalacia in 20 children, with a sensitivity of 54.1% (95%CI 37.1-70.2), specificity = 87.5% (95%CI 60.4-97.8), and positive predictive value = 90.9% (95%CI 69.4-98.4). The agreement between pediatric pulmonologists for diagnosing tracheomalacia by FB was excellent, weighted κ = 0.8 (95%CI 0.64-0.97); but only fair between the pairs of pediatric pulmonologists/radiologists for VB, weighted κ = 0.47 (95%CI 0.23-0.71). There were 42 cases of bronchomalacia detected on FB. VB had a sensitivity = 45.2% (95%CI 30.2-61.2), specificity = 95.5% (95%CI 94.2-96.5), and positive predictive value = 23.2 (95%CI 14.9-34.0) compared to FB in detecting bronchomalacia. CONCLUSION VB cannot replace FB as the gold standard for detecting tracheobronchomalacia in children. However, VB could be considered as an alternative diagnostic modality in children with symptoms suggestive of tracheobronchomalacia where FB is unavailable. Pediatr Pulmonol. 2017;52:480-486. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Siew Choo Su
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia.,Respiratory Unit, Department of Pediatrics, Hospital Tengku Ampuan Rahimah, Jalan Langat, Klang 41200, Selangor, Malaysia
| | - Ian Brent Masters
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia
| | - Helen Buntain
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia
| | - Kieran Frawley
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anubhav Sarikwal
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Debbie Watson
- Department of Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Frances Ware
- Department of Anesthesia, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jan Wuth
- Department of Anesthesia, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Anne Bernadette Chang
- Queensland Children's Respiratory Centre and Children's Centre Health Research, Brisbane, Queensland, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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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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Abstract
Imaging has played a vital role in the clinical assessment of bronchopulmonary dysplasia (BPD) since its first recognition. In this review, how chest radiograph, computerized tomography (CT), nuclear medicine, and MRI have contributed to the understanding of BPD pathology and how emerging advancements in these methods, including low-dose and quantitative CT, sophisticated proton and hyperpolarized-gas MRI, influence the future of BPD imaging are discussed.
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Affiliation(s)
- Laura L Walkup
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MC 5033, Cincinnati, OH 42229, USA
| | - Jason C Woods
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MC 5033, Cincinnati, OH 42229, USA.
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Giannoni CM, Guillerman RP. Computed Tomography for the Evaluation of Suspected Airway Foreign Bodies. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66:570-582.e5. [DOI: 10.1016/j.annemergmed.2015.07.499] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 12/27/2022]
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Karande S, Vaideeswar P, Muranjan M. Muddy clinical waters: a missed betel nut in the bronchus. BMJ Case Rep 2015; 2015:bcr-2015-212919. [PMID: 26598528 DOI: 10.1136/bcr-2015-212919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A toddler presented with a 5-month history of recurrent episodes of cough, wheezing and fever. Before referral, the toddler had been initially diagnosed as having bronchial asthma and later as having pulmonary tuberculosis. On examination, the patient was febrile and had severe respiratory distress. Chest radiograph and high-resolution CT of the chest revealed collapse of the entire left lung with diffuse bronchiectasis along with a grossly hyperinflated right lung. CT virtual bronchoscopy did not reveal any foreign body. The parents denied any history suggestive of foreign body aspiration and refused consent for rigid bronchoscopy. Nine days after admission, chest physiotherapy was inadvertently prescribed to the patient. Within an hour, the patient experienced acute respiratory deterioration and died. Autopsy revealed a piece of betel nut in the right main bronchus; it had got dislodged from its initial site in the left main bronchus following the chest physiotherapy session.
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Affiliation(s)
- Sunil Karande
- Department of Pediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Pradeep Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Mamta Muranjan
- Department of Pediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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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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Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree. The Journal of Laryngology & Otology 2014; 128:1078-83. [PMID: 25388230 DOI: 10.1017/s0022215114002837] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children. METHODS The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy. RESULTS A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent. CONCLUSION Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.
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Madan K, Agarwal R, Aggarwal AN, Gupta D. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature. Lung India 2014; 31:9-15. [PMID: 24669075 PMCID: PMC3960825 DOI: 10.4103/0970-2113.125887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures) were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65) min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.
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Affiliation(s)
- Karan Madan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India ; Department of Pulmonary Medicine, and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Akiba T. Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg 2013; 61:676-84. [DOI: 10.1007/s11748-013-0336-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Indexed: 02/06/2023]
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Virtual bronchoscopy in the era of multi-detector computed tomography: Is there any reality? Med J Armed Forces India 2013; 69:305-10. [PMID: 24600130 DOI: 10.1016/j.mjafi.2012.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 12/05/2012] [Indexed: 11/22/2022] Open
Abstract
Virtual bronchoscopy, in conjunction with axial and MPR MDCT images, can enhance diagnostic accuracy of tracheo-bronchial endoluminal pathologies. We describe a few cases highlighting the utility of virtual bronchoscopy in the diagnosis of varied tracheo-bronchial pathologies encountered in the setting of a tertiary care Armed Forces Hospital of India.
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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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3D images based on MDCT in evaluation of patients with suspected foreign body aspiration. Eur Arch Otorhinolaryngol 2012; 270:1001-7. [PMID: 23161276 DOI: 10.1007/s00405-012-2279-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
To evaluate the value of 3D images based on multi-detect computer tomography (MDCT) for the diagnosis and management of patients with suspected foreign bodies aspiration, and report our experience about diagnosis and management of the aforementioned patients using the 3D images, as well as detail our protocol for the management of those patients. Forty-four patients (37 children, 7 adults) with suspected foreign bodies aspiration who accepted pre-surgical examination and bronchoscopy in our hospital were included in this study. All the patients' pre-surgical 3D images based on MDCT were reconstructed and analyzed. After that all the results were compared with observations in the surgeries. Among the 37 pediatrics, 34 patients were detected with FB in their tracheobronchial system by the 3D images based on MDCT, and 3 cases were detected negative. The sensitivity of 3D images is 100 %, and the specificity is 75 %.In the adult group, all the 7 cases of FB in the tracheobronchial tree were detected by 3D images and proved by bronchoscopy. 3D images based on MDCT were proved to be a valuable method for the diagnosis of the patients with suspected FB aspiration. In the diagnosis and management of those patients, we considered that both the typical FB aspiration history and the intractable symptoms of cough should be taken as the criteria and the first step for selecting those suspected patients; then 3D images based on MDCT could be taken as the second step and as the selective criteria for those patients who should accept the rigid bronchoscopy.
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Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body. Int J Pediatr Otorhinolaryngol 2012; 76:194-201. [PMID: 22154779 DOI: 10.1016/j.ijporl.2011.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives. METHODS We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy. RESULTS Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB. CONCLUSIONS Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.
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Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol 2011; 269:223-8. [DOI: 10.1007/s00405-011-1567-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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