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Park, Kim, Lee, Lee, Yang, Kim, Chun, Yoon, Im, Kim, and Kim: Chest radiographs and computed tomography scans in children with airway foreign body
Original Article

Allergy Asthma Respir Dis 2018;6(5):241-247.

Published online: 5 September 2018

DOI: https://doi.org/10.4168/aard.2018.6.5.241

Chest radiographs and computed tomography scans in children with airway foreign body

Yu Mi Park1, Kyunghoon Kim1, Hye Jin Lee1, Eu Kyoung Lee2, Eun Ae Yang1, Hwan Soo Kim1, Yoon Hong Chun1, Jong-Seo Yoon1, Soo Ah Im3, Hyun Hee Kim1, Jin Tack Kim1

1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea

2Kaya Pediatrics, Seoul, Korea

3Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Eu Kyoung Lee https://orcid.org/0000-0001-5740-9593 Kaya Pediatrics, 225 Bangbae-ro, Seocho-gu, Seoul 06561, Korea Tel: +82-2-537-1118, Fax: +82-2-537-0017, E-mail: euneun99@gmail.com

Received 27 December 201719 June 2018       Accepted 30 June 2018

Copyright © 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration.

Methods

A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy.

Results

As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively.

Conclusion

There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.

Keywords: X-ray computed tomography, Child, Foreign bodies

REFERENCES

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Table 1.
Patient characteristics and clinical features (n=32)
Characteristic Value
Age (mo)  
 Mean±SD 23.0±21.2
 Median (range) 17.5 (8.0–125.0)
Male sex 22 (68.8)
Chocking history 22 (68.8)
Clinical symptoms  
 Cough 25 (78.1)
 Dyspnea 8 (25)
 Wheezy respiration 5 (15.6)
 Fever 5 (15.6)
 Cyanosis 4 (12.5)
 Vomiting 2 (6.3)
 Grunting 1 (3.1)
 Stridor 1 (3.1)
 No symptom 1 (3.15)
Breathing sounds  
 Decreased breathing sound 13 (40.6)
 Wheezing 12 (37.5)
 Clear breathing sound 4 (12.5)
 Stridor 2 (6.3)
 Rhonchi 2 (6.3)
 Crackle 2 (6.3)

Values are presented as number of patients (%) unless otherwise indicated.

Table 2.
Foreign body removal method, type, and location of foreign body (n=25)
Characteristic No. of patients (%)
Foreign body removal  
 Flexible bronchoscopy 13 (52.0)
 Rigid bronchoscopy 9 (36.0)
 Surgical removal 2 (8.0)
 Self-removal 1 (4.0)
Foreign body type  
 Organic foreign body  
  Peanut 10 (40.0)
  Almond 3 (12.0)
  Other nuts 2 (8.0)
  Chestnut 2 (8.0)
  Bean 2 (8.0)
  Cone 1 (4.0)
  Soft bone 1 (4.0)
Inorganic foreign body  
  Lego piece 1 (4.0)
  Metal spring 1 (4.0)
  Vinyl 1 (4.0)
  Metal screw 1 (4.0)
Foreign body location  
 Trachea 4 (16.0)
 Right main bronchus 7 (28.0)
 Left main bronchus 10 (40.0)
 Right bronchus intermedius 4 (16.0)
Table 3.
The accuracy of radiologic findings in evaluation of suspected foreign bodies
Imaging Foreign body (n) No foreign body (n) Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (95% CI)
Chest AP or PA (n=29)              
 Positive 12 0 50.0 100.0 100.0 29.4 58.6% (0.39–0.76)
 Negative 12 5          
Chest both down decubitus (n=23)              
 Positive 11 2 57.9 50.0 84.6 20.0 56.5% (0.34–0.77)
 Negative 8 2          
Chest (AP or PA) or chest both down decubitus (n=29)              
 Positive 16 2 69.6 66.7 88.8 36.4 69.0% (0.49–0.85)
 Negative 7 4          
Chest CT (n=27)              
 FB (+) 20 1 100.0 85.7 95.0 100.0 96.2% (0.80–0.99)
 FB (-) 0 6          

Values are presented as number.

PPV, positive predictive value; NPV, negative predictive value; CI, confidential interval; AP, anteroposterior; PA, posteroanterior; CT, computed tomography; FB, foreign body; Positive finding: air trapping (unilateral hyperinflation or decreased radiodensity).

Table 4.
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of chest radiograph and chest CT for the diagnosis of bronchial foreign body according to various studies
Variable Current study Brown et al.16 Assefa et al.19 Heyer et al.12 Sattar et al.14 Ciftci et al.3 Ayed et al.9 Haliloglu et al.23 Hong et al.22
Country South Korea Seattle USA Germany Pakistan Turkey Kuwait Turkey South Korea
Study period 2012–2017 1997–2008 1996–2001 1992–2000 2009–2011 1991–2000 1996–2000 2000–2001 2003–2007
Study design Retrospective Retrospective Retrospective Retrospective Retrospective Retrospective Retrospective Retrospective Retrospective
Age 0–11 yr 0–16 yr <4 yr - - - 7 mo–15 yr - -
Single/multicenter r Single center Single center Single center Multiple center Single center Single center Single center Single center Single center
Chest AP or PA                  
 Sensitivity (%) 50.0 56.0 55.0 62.3 66.6 88.0 66.0 85.0  
 Specificity (%) 100.0 79.0 50.0 97.4 50.0 30.0 48.0 68.0  
 PPV (%) 100.0 37.0 80.0 98.7 89.6 88.0 90.0    
 NPV (%) 29.4 89.0 23.0 44.6 18.7 36.0 17.0    
 Accuracy (%) 58.6         79.0   74.0  
Chest both down decubitus
 Sensitivity (%) 57.9   27.0            
 Specificity (%) 50.0   67.0            
 PPV (%) 84.6   75.0            
 NPV (%) 20.0   20.0            
Chest (AP or PA) or chest both down decubitus
 Sensitivity (%) 69.6 56.0              
 Specificity (%) 66.7 64.0              
 PPV (%) 88.8 25.0              
 NPV (%) 36.4 87.0              
 Chest CT                  
 Sensitivity (%) 100.0             100.0 100.0
 Specificity (%) 85.7             100.0 60.7
 PPV (%) 95.0               93.3
 NPV (%) 100.0               100.0
 Accuracy (%) 96.2               94.1

CT, computed tomography; AP, anteroposterior; PA, posteroanterior.

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