Two new radiological findings to improve the diagnosis of bronchial foreign-body aspiration in children

Our objective was to report on two new chest X-ray signs (hyperinflation or obstructive emphysema with atelectasis in the same hemithorax, and aeration within an area of atelectasis) in children with foreign-body aspiration (FBA). We performed a retrospective review of clinical characteristics and chest X-ray films of 133 children with FBA. Of 133 children, 45% were under 3 years old. History of a choking crisis was present in 101 (75.8%); however, it was only elicited upon follow-up questioning in 33 children (32.7%). Early foreign-body (1713) extraction (<24 hr) was performed in 17.3%; removal took place between 1-7 days in 29.3%. The site of aspirated FBs was bronchial in 78.9%, laryngeal in 6%, and tracheal in 4.5%, with mobile FB in the trachea/bronchi in 4.5%. The chest X-ray was normal in 11.3%. Positive findings included: radiopaque FB (23.3%); hyperinflation or obstructive emphysema (21.8%); hyperinflation or obstructive emphysema with atelectasis in the same hemithorax (18%); lobar atelectasis (12.8%); whole-lung atelectasis (6.8%); shift of mediastinal shadow (11%); and aeration within an area of atelectasis (6%). In conclusion, if a history of choking crisis is not present in a child with suspected FBA, two previously undescribed radiological signs (hyperinflation or obstructive emphysema with atelectasis in the same hemithorax, and aeration within an area of atelectasis) should be sought in order to improve the utility of chest-X ray for early diagnosis of FBA.