Predictors of radiolucent foreign body aspiration.
BACKGROUND
Children frequently present for suspected foreign body aspiration, many have mild symptoms and/or negative radiographs raising the question of a radiolucent foreign body aspiration.


METHODS
Retrospective review of patients having bronchoscopy for suspected radiolucent foreign body aspiration from 2000 to 2010 collecting demographics, history, hospital presentation, radiographic, and operative details. Pearson's correlation was used between event history, presentation, radiographic details and bronchoscopically identified foreign body with P value <0.01.


RESULTS
138 patients, mean age 2.6 years, mean weight 15.6 kg, 68% male. Event symptoms: 81% witnessed events, 64% wheezing, 43% coughing, 39% choking, 6% stridor, and 0.7% lethargy. Hospital presentation: 70% persistent symptoms, wheezing 56%, coughing 15%, desaturations 11%, stridor 7%, choking 4%, and lethargy 1%. 92% of patients had a chest x-ray; air trapping found in 38%, and lung collapse in 21%. 2 patients received CT scans; 1 had lung collapse. Bronchoscopy identified foreign bodies in 93% of patients: food 68%, plastic 18%, non-descript 11%, rocks 3%. No correlations between event symptoms, hospital presentation, radiographs and foreign body presence.


CONCLUSIONS
Event history, hospital presentation, and radiographs are insufficient in proving the absence of a radiolucent foreign body. Patients with suspected radiolucent foreign body aspiration should undergo diagnostic bronchoscopy prior to discharge.
Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
Vincent E
VE
Mortellaro
Corey
C
Iqbal
Roxanna
R
Fu
Heather
H
Curtis
Frankie B
FB
Fike
Shawn D
SD
St Peter
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D005260:Female; D005502:Food; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D053609:Lethargy / Q000209:etiology; D008297:Male; D010969:Plastics; D011030:Pneumothorax / Q000209:etiology; D053120:Respiratory Aspiration / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies; D063189:Symptom Assessment; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed
D010969:Plastics
Aspiration; Foreign body; Inhalation; Radiolucent