Advantage of Computed Tomography (CT) Virtual Bronchoscopy in the Evaluation of Children with Suspected Foreign Body Airway

摘要

Background & Objectives: Foreign body aspiration (FBA) into the tracheo bronchial tree is a frequent and serious cause of respiratory distress and visit to the pediatrics emergency, principally in patients under 3 years of age. Most foreign bodies are not radio opaque and approximately one third of the children admitted will show normal chest X-ray. Virtual bronchoscopy is a relatively new and non-invasive procedure that provides a three dimensional view of the internal walls of the tracheobronchial tree through the reconstruction of axial images. The objectives of the study are, 1) to study the diagnostic accuracy and advantage of virtual bronchoscopy over rigid bronchoscopy in the evaluation of children with suspected FBA and to plan for early management as it is a non-invasive technique; 2) to study the clinical spectrum of children attending with suspected FBA. Methods: An observational study of 37 patients of age 12 yrs and below who underwent Virtual Bronchoscopy for suspected foreign body aspiration in the department of pediatrics and Otorhinolaryngology at MGM Hospital, Warangal is carried out for a period of 1.5 years during 2012-2013. Results: The common age of presentation was 1 - 3 years with male preponderance. History of foreign body was obtained in 64.86% of cases. Normal X-ray was found in 27.02% of cases. In 75.67% FB detected on rigid bronchoscopy was also revealed on virtual bronchoscopy. False positive percentage was 5.40% and false negative was 2.70%. Sensitivity and specificity was 96.5% and 75% respectively. Ground nuts were the commonest foreign bodies aspirated. Conclusion: Virtual bronchoscopy should be considered in cases with suspected foreign body aspiration, when chest X-ray is normal, to avoid needless rigid bronchoscopy. Virtual bronchoscopy is useful in screening cases of occult foreign body as it has sensitivity, specificity, and validity.