Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T16:53:10.190Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  17 November 2014

P Tuckett*
Affiliation:
School of Medicine, University of Queensland, Brisbane, Australia
A Cervin
Affiliation:
School of Medicine, University of Queensland, Brisbane, Australia Department of Otolaryngology Head and Neck Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia
*
Address for correspondence: Mr Paul Tuckett, 51 Wilga Street, Wacol, Queensland 4076, Australia E-mail: [email protected]

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.

Type
Review Article
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Paksu, S, Paksu, MS, Kilic, M, Guner, SN, Baysal, K, Sancak, R et al. Foreign body aspiration in childhood: evaluation of diagnostic parameters. Pediatr Emerg Care 2012;28:259–64Google Scholar
2Maddali, MM, Mathew, M, Chandwani, J, Alsajwani, MJ, Ganguly, SS.Outcomes after rigid bronchoscopy in children with suspected or confirmed foreign body aspiration: a retrospective study. J Cardiothorac Vasc Anesth 2011;25:1005–8Google Scholar
3Fidkowski, CW, Zheng, H, Firth, PG.The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesth Analg 2010;111:1016–25CrossRefGoogle Scholar
4Hasdiraz, L, Oguzkaya, F, Bilgin, M, Bicer, C.Complications of bronchoscopy for foreign body removal: experience in 1,035 cases. Ann Saudi Med 2006;26:283–7CrossRefGoogle Scholar
5Chen, LH, Zhang, X, Li, SQ, Liu, YQ, Zhang, TY, Wu, JZ.The risk factors for hypoxemia in children younger than 5 years old undergoing rigid bronchoscopy for foreign body removal. Anesth Analg 2009;109:1079–84CrossRefGoogle ScholarPubMed
6Tomaske, M, Gerber, AC, Weiss, M.Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Pediatr Anaesth 2006;16:123–9Google Scholar
7Kiyan, G, Gocmen, B, Tugtepe, H, Karakoc, F, Dagli, E, Dagli, TE.Foreign body aspiration in children: the value of diagnostic criteria. Int J Pediatr Otorhinolaryngol 2009;73:963–7Google Scholar
8Ezer, SS, Oguzkurt, P, Ince, E, Temiz, A, Caliskan, E, Hicsonmez, A.Foreign body aspiration in children: analysis of diagnostic criteria and accurate time for bronchoscopy. Pediatr Emerg Care 2011;27:723–6Google Scholar
9Ciftci, AO, Bingol-Kologlu, M, Senocak, ME, Tanyel, FC, Buyukpamukcu, N.Bronchoscopy for evaluation of foreign body aspiration in children. J Pediatr Surg 2003;38:1170–6CrossRefGoogle ScholarPubMed
10Korlacki, W, Korencka, K, Dzielicki, J.Foreign body aspiration in children: diagnostic and therapeutic role of bronchoscopy. Pediatr Surg Int 2011;27:833–7Google Scholar
11Lea, E, Nawaf, H, Yoav, T, Elvin, S, Ze'ev, Z, Amir, K.Diagnostic evaluation of foreign body aspiration in children: a prospective study. J Pediatr Surg 2005;40:1122–7Google Scholar
12Rizk, H, Rassi, S.Foreign body inhalation in the pediatric population: lessons learned from 106 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:169–74Google Scholar
13Soysal, O, Kuzucu, A, Ulatas, H.Tracheobronchial foreign body aspiration: a continuing challenge. Otolaryngol Head Neck Surg 2006;135:223–6Google Scholar
14Even, L, Heno, N, Talmon, T, Samet, E, Zonis, Z, Kugelman, A.Diagnostic evaluation of foreign body aspiration in children: a prospective study. J Pediatr Surg 2005;40:1122–7Google ScholarPubMed
15Mu, L, Sun, D, He, P.Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases. J Laryngol Otol 1990;104:778–82Google Scholar
16Jiaqiang, S, Jingwu, S, Yanming, H, Qiuping, L, Yinfeng, W, Xianguang, L et al. Rigid bronchoscopy for inhaled pen caps in children. J Pediatr Surg 2009;44:1708–11Google Scholar
17Orji, FT, Akpeh, JO.Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis? Clin Otolaryngol 2010;35:479–85CrossRefGoogle ScholarPubMed
18Australian Institute of Health and Welfare. Australian Hospital Statistics 2009–10, Health services series no. 40, cat. no. HSE 107. Canberra: AIHW, 2011Google Scholar
19Ozkurt, H, Bahadir, E, Uegul, A, Altuna, C, Basak, M, Cevizci, NM et al. Comparison of multidetector computed tomography-virtual bronchoscopy and conventional bronchoscopy in children with suspected foreign body aspiration. Emerg Radiol 2008. Epub 2008 Nov 17CrossRefGoogle ScholarPubMed
20Cevizci, N, Dokucu, A, Baskin, D, Karadag, C, Sever, N, Yalcin, M et al. Virtual bronchoscopy as a dynamic modality in the diagnosis and treatment of suspected foreign body aspiration. Eur J Pediatr Surg 2008;18:398401CrossRefGoogle ScholarPubMed
21Manach, Y, Pierrot, S, Couloigner, V, Ayari-Khalfallah, S, Nicollas, R, Venail, F et al. Diagnostic performance of multidetector computed tomography for foreign body aspiration in children. Int J Pediatr Otorhinolaryngol 2013;77:808–12CrossRefGoogle ScholarPubMed
22Bhat, K, Hedge, J, Nagalotimath, U, Patil, G.Evaluation of computed tomography virtual bronchoscopy in paediatric tracheobronchial foreign body aspiration. J Laryngol Otol 2010;124:875–9Google Scholar
23Doğan, S, Coskun, A, Yikilmaz, A, Hasdiraz, L, Tahan, F.The value of low-dose multidetector CT and virtual bronchoscopy findings in pediatric patients with suspected foreign body aspiration [in Turkish]. Erciyes Tip Dergisi 2008;30:7883Google Scholar
24Jung, SY, Pae, SY, Chung, SM, Kim, HS.Three-dimensional CT with virtual bronchoscopy: a useful modality for bronchial foreign bodies in pediatric patients. Eur Arch Otorhinolaryngol 2012;269:223–8CrossRefGoogle ScholarPubMed
25Bai, W, Zhou, X, Gao, X, Shao, C, Califano, JA, Ha, PK.Value of chest CT in the diagnosis and management of tracheobronchial foreign bodies. Pediatr Int 2011;53:515–18CrossRefGoogle ScholarPubMed
26Sodhi, KS, Aiyappan, SK, Saxena, AK, Singh, M, Rao, K, Khandelwal, N.Utility of multidetector CT and virtual bronchoscopy in tracheobronchial obstruction in children. Acta Paediatr 2010;99:1011–15Google Scholar
27Kosucu, P, Ahmetoglu, A, Koramaz, I, Orhan, F, Ozdemir, O, Dinc, H et al. Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration. AJR Am J Roentgenol 2004;183:1771–7Google Scholar
28Tong, B, Zhang, L, Fang, R, Sha, Y, Chi, F.3D images based on MDCT in evaluation of patients with suspected foreign body aspiration. Eur Arch Otorhinolaryngol 2013;270:1001–7Google Scholar
29Sarsilamz, A, Boyraz, E, Gelal, F.CT virtual bronchoscopic evaluation in pediatric patients with suspected foreign body aspiration [in Turkish]. Anatolian Journal of Clinical Investigation 2011;5:135–9Google Scholar
30Kocaoglu, M, Bulakbasi, N, Soylu, K, Demirbag, S, Tayfun, C, Somuncu, I.Thin-section axial multidetector computed tomography and multiplanar reformatted imaging of children with suspected foreign-body aspiration: is virtual bronchoscopy overemphasized? Acta Radiol 2006;47:746–51CrossRefGoogle ScholarPubMed
31Haliloglu, M, Ciftci, AO, Oto, A, Gumus, B, Tanyel, FC, Senocak, ME et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol 2003;48:188–92CrossRefGoogle ScholarPubMed
32Hong, W, Im, S, Kim, H, Yoon, J.CT evaluation of airway foreign bodies in children: emphasis on the delayed diagnosis and differentiation from airway mucus plugs. Jpn J Radiol 2013;31:31–8CrossRefGoogle ScholarPubMed
33Hong, S-J, Goo, HW, Roh, J-L.Utility of spiral and cine CT scans in pediatric patients suspected of aspirating radiolucent foreign bodies. Otolaryngol Head Neck Surg 2008;138:576–80CrossRefGoogle ScholarPubMed
34Webb, D, Solomon, S, Thomson, J.Background radiation levels and medical exposure in Australia. Radiation Protection in Australia 1999;16:714Google Scholar
35Sattar, A, Javed, AM, Bodla, MA, Anjum, S, Ch, SU.Multidetector CT chest in the diagnosis and management of tracheobronchial foreign bodies in pediatric patients. Nishtar Medical Journal 2010;2:6973Google Scholar
36Sodhi, K, Saxena, A, Singh, M, Rao, K, Khandelwal, N.CT virtual bronchoscopy: new non invasive tool in pediatric patients with foreign body aspiration. Indian J Pediatr 2008;75:511–13CrossRefGoogle ScholarPubMed
37Adeletli, I, Kurugoglu, S, Ulus, S, Ozer, H, Elicevik, M, Kantarci, F et al. Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration. Pediatr Radiol 2007;37:3340CrossRefGoogle Scholar
38Ransohoff, D, Feinstein, A.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978;299:926–30CrossRefGoogle ScholarPubMed
39Brenner, D, Elliston, C, Hall, E, Berdon, W.Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289–96CrossRefGoogle ScholarPubMed
40Stender, H.The omitted x-ray examination--benefit and risk--a comparison [in German]. Aktuelle Radiol 1993;3:135–9Google ScholarPubMed
41Mathews, J, Forsythe, A, Brady, Z, Butler, M, Goergen, S, Byrnes, G et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013;346:f2360Google Scholar
42Newman, B, Ganguly, A, Kim, J, Robinson, T.Comparison of different methods of calculating CT radiation effective dose in children. AJR Am J Roentgenol 2012;199:W232–9CrossRefGoogle ScholarPubMed
43Frush, D, Donelly, L, Rosen, N.Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 2003;112:951–7Google Scholar
44Brisse, H, Aubert, B.CT exposure from pediatric MDCT: results from the 2007–2008 SFIPP/ISRN survey [in French]. J Radiol 2009;90:207–15Google Scholar
45Cavel, O, Bergeron, M, Garel, L, Arcand, P, Froehlich, P.Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body. Int J Pediatr Otorhinolaryngol 2012;76:194201Google Scholar