Diagnostic value of various investigations in children with suspected foreign body aspiration: review

Foreign body aspiration is a serious condition during childhood that requires prompt management to avoid complications and irreversible lung injury. Rigid bronchoscopy under general anaesthesia is the procedure of choice for removal of aspirated foreign bodies, but it can be associated with serious complications. The positive diagnosis can sometimes be challenging except in the case of radiopaque or obstructive foreign bodies, due to the low sensitivity and specificity of clinical history and physical examination. The aim of this review is to evaluate the various investigations in children with suspected foreign body aspiration, in order to reduce the negative rigid bronchoscopy rate. Review of the literature based on Medline data between 1980 and 2010. Chest radiography during inspiration and expiration, often performed as the first-line radiographic investigation, has a low sensitivity and specificity. In the absence of a radiopaque foreign body, obstructive emphysema is the most specific radiographic sign. Airway fluoroscopy can complete chest radiography when radiographic signs are nonspecific. Flexible bronchoscopy is the most sensitive and most specific examination, but is not always available, as it must be performed in the operating room or with resuscitation equipment at hand. This procedure should be performed when foreign body aspiration is suspected in the absence of typical clinical and radiological signs. It can decrease the number of negative rigid bronchoscopies. Several studies suggest that chest CT is also a very sensitive examination in this indication. The sensitivity and specificity of chest CT for the diagnosis of bronchial foreign body must be validated by a prospective study. A national multicentre study is currently underway to determine whether CT can replace flexible bronchoscopy when the diagnosis of bronchial foreign body is uncertain.