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Foreign body aspiration in children

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Background: The aim was to investigate the role of physical and radiological findings before bronchoscopy in the diagnosis of foreign body aspiration (FBA).

Methods: We retrospectively reviewed the clinical records for 82 patients (mean age 26.4 ± 21.4 months, range 9 months to 13.5 years; 49 males) with a history suggestive of foreign body aspiration.

Results: The presence of a foreign body in the airways was confirmed in 70 children (85.4%) (mean age 25 ± 14.1 months, 45 boys). Of the 70 children, 63 patients (90%) were under 3 years of age, with a peak incidence during the second year. Of the 70 foreign bodies retrieved, 46 (60%) were vegetable and 35 (76%) of these were nuts. In 42% of the patients the foreign body was located in the right bronchial tree. The most frequent physical findings observed in our patients were persistent cough (75%), localized decreased breath sound (62.8%) and localized wheezing (30%). The clinical triad (concomitant cough, localized wheezing and decreased breath sound) was present in 11 patients (15.7%). All clinical findings had a high positive predictive value with poor sensitivity. In 11 patients (20%) chest X-rays were normal. Five foreign bodies (9.1%) were radiopaque. The most frequent radiological findings observed were localized air trapping (43.6%), followed by atelectasis (40%). The diagnostic sensitivity was 80% and the specificity 33% for the presence of a single positive radiological finding.

Conclusions: Our study confirmed that clinical symptoms and radiological findings before bronchoscopy have a low diagnostic value in children with a history of FBA.
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Keywords: bronchoscopy; children; foreign body aspiration

Document Type: Research Article

Affiliations: 1: Department of Pediatrics, University ‘La Sapienza’ of Rome, Rome 2: Department of Pediatrics, University of Padova, Padova 3: Department of Pediatrics, University of Perugia, Perugia 4: Department of Pediatrics, University of Pavia, Pavia 5: Department of Pediatrics, University of Pisa, Pisa 6: Department of Pediatrics, ‘Salesi’ Childrens’ Hospital Ancona, Ancona, Italy

Publication date: 01 December 2005

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