Emergency Paediatric Airway Imaging: Should MDCT Precede Bronchoscopy in Suspicious Cases of Foreign Body Aspiration?

Introduction: Acute onset paediatric respiratory distress with suspicion of Foreign Body (FB) aspiration often demands a quick diagnostic and therapeutic approach. While, Rigid Bronchoscopy (RB) is the Gold Standard diagnostic and therapeutic management, Multi Detector Computed Tomography (MDCT) also has a superb diagnostic capability. However, in this emergent condition, which modality is the quickest, most comprehensive and hassle free in confirming diagnosis, needs to be ascertained. Aim: To evaluate the efficacy of MDCT in diagnosing airway obstruction in paediatric patients with acute onset respiratory distress and suspicion of FB aspiration; thereby directing the need for invasive manoeuvres. Materials and Methods: A retrospective observational study was done in the Department of Radio-Diagnosis of Pramukhswami Medical College, Anand, Gujarat, India. MDCT Thorax findings of 19 consecutive paediatric patients; who presented with acute onset respiratory distress and suspicion of FB aspiration from June 2016 to May 2018 were analysed. Both source and reconstructed images were analysed and MDCT data was compared with RB findings. Results: In detecting removable airway obstruction and advising for bronchoscopy, MDCT showed a sensitivity of 92.31%, specificity 100% and an overall accuracy of 94.74%. While analysing the type of airway obstruction, with two false negatives, MDCT showed a sensitivity of 81.82% and specificity of 100% and an accuracy of 89.47%. MDCT was successful in preventing unnecessary bronchoscopy six out of seven times with an accuracy of 85.7%. Conclusion: Clinical suspicion of FB aspiration in paediatric acute onset respiratory distress cases may not always be correct and an alternate diagnosis is often to be considered. Therefore, an efficient and comprehensive radiological insight is necessary before going for an invasive bronchoscopy which is aptly provided by MDCT