Clinico-radiological parameters predicting early diagnosis of foreign body aspiration in children

Yıl 2016, Cilt: 26 Sayı: 5, 268 - 275, 20.10.2016

Pradipta Kumar Parida Nirmal Shanmugasundaram Surianarayanan Gopalakrishnan

Öz

Objectives: This study aims to investigate clinical and radiological findings to make early diagnosis of foreign body FB aspiration in children. Patients and Methods: This prospective study was conducted on 45 children younger than 12 years with a clinical diagnosis of FB aspiration undergone rigid bronchoscopy between September 2010 and May 2014. The results of 37 children 22 males, 15 females; mean age 2.6 years; range 1 to 12 years with positive for FB on bronchoscopy were analyzed. Results: Penetration syndrome sudden onset coughing, choking and gagging 89.2% and decreased breath sounds 86.5% were the most common clinical features. Cough, respiratory difficulty and fever were present in 83.8%, 78.4% and 27% respectively. Tachypnea, tachycardia, chest retractions, decreased chest movements and wheeze were present in 83.3%, 83.3%, 83.3%, 51.4% and 43.2% respectively. Unilateral hyperinflation 64.9% , mediastinal shift 45.9% , and collapse 21.6% were common radiological signs on chest radiography and in 13.5% patients the chest X-rays were normal. Sites of FB lodgements were larynx, trachea, right main bronchus, left main bronchus and bilateral bronchi in 10.8%, 10.8%, 35.1%, 37.8 and 5.5% respectively. Food related FBs were present in 30 cases peanut 54.1% and inorganic FBs were present in seven cases. Conclusion: Penetration syndrome, localized decreased breath sounds, unilateral hyperinflation and/or mediastinal shift on radiology are predictors for early diagnosis of FB aspiration.

Anahtar Kelimeler

Bronchoscopy, bronchus, foreign bodies, foreign body aspiration

Çocuklarda yabancı cisim aspirasyonu erken tanısını öngören klinik-radyolojik parametreler

Öz

Amaç: Bu çalışmada çocuklarda yabancı cisim YC aspirasyonu erken tanısı için klinik ve radyolojik bulgular araştırıldı.Hastalar ve Yöntemler: Bu prospektif çalışma Eylül 2010 - Mayıs 2014 tarihleri arasında, YC aspirasyonu klinik tanısı ile rijid bronkoskopi uygulanan 12 yaşından küçük 45 çocuk ile yürütüldü. Otuz yedi YC pozitif çocuğun sonuçları 22 erkek, 15 kız; ort. yaş 2.6 yıl; dağılım 1-12 yıl bronkoskopi ile analiz edildi.Bulgular: Penetrasyon sendromu ani başlangıçlı öksürük, boğulma ve tıkanma %89.2 ve azalmış solunum sesleri %86.5 en sık görülen klinik özelliklerdi. Öksürük, solunum zorluğu ve ateş sırasıyla %83.8, %78.4 ve %27 idi. Takipne, taşikardi, göğüs çekilmeleri, azalmış göğüs hareketleri ve hırıltı sırasıyla %83.3, %83.3, %83.3, %51.4 ve %43.2 idi. Tek taraflı hiperinflasyon %64.9 , mediastinal şift %45.9 ve çökme %21.6 akciğer grafisinde ve göğüs röntgenlerinde ortak radyolojik bulgulardı ve hastaların %13.5’inin akciğer filmi normaldi. Yabancı cisim yerleşim yerleri gırtlak, soluk borusu, sağ ana bronş, sol ana bronş ve iki taraflı bronşlarda sırasıyla %10.8, %10.8, %35.1, %37.8 ve %5.5 idi. Gıda ile ilgili YC’ler 30 olguda yer fıstığı %54.1 ve inorganik YC yedi olguda mevcuttu.Sonuç: Penetrasyon sendromu, lokalize solunum sesleri azalması, tek taraflı hiperenflasyon veya radyolojide mediastinal şift YC aspirasyonu erken tanısı için gösterge niteliğindedir

Anahtar Kelimeler

Bronkoskopi, bronş, yabancı cisimler, yabancı cisim aspirasyonu

Kaynakça

• Jackson C, Jackson CL. Diseases of the air and food passages of foreign body origin. Philadelphia: W.B Saunders Co; 1936.
• Svedström E, Puhakka H, Kero P. How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children? Pediatr Radiol 1989;19:520-2.
• Steen KH, Zimmermann T. Tracheobronchial aspiration of foreign bodies in children: a study of 94 cases. Laryngoscope 1990;100:525-30.
• Mantor PC, Tuggle DW, Tunell WP. An appropriate negative bronchoscopy rate in suspected foreign body aspiration. Am J Surg 1989;158:622-4.
• Zerella JT, Dimler M, McGill LC, Pippus KJ. Foreign body aspiration in children: value of radiography and complications of bronchoscopy. J Pediatr Surg 1998;33:1651-4.
• Black RE, Johnson DG, Matlak ME. Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg 1994;29:682-4.
• Wiseman NE. The diagnosis of foreign body aspiration in childhood. J Pediatr Surg 1984;19:531-5.
• Banerjee A, Rao KS, Khanna SK, Narayanan PS, Gupta BK, Sekar JC, et al. Laryngo-tracheo-bronchial foreign bodies in children. J Laryngol Otol 1988;102:1029-32.
• Narasimhan KL, Chowdhary SK, Suri S, Mahajan JK, Samujh R, Rao KLN. Foreign body airway obstructions in children- lessons learnt from a prospective audit. J Indian Assoc Pediatr Surg 2002;7:184-9.
• Tahir N, Ramsden WH, Stringer MD. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr 2009;168:289-95.
• Roh JL, Hong SJ. Lung recovery after rigid bronchoscopic removal of tracheobronchial foreign bodies in children. Int J Pediatr Otorhinolaryngol 2008;72:635-41.
• Chik KK, Miu TY, Chan CW. Foreign body aspiration in Hong Kong Chinese children. Hong Kong Med J 2009;15:6-11.
• Roda J, Nobre S, Pires J, Estêvão MH, Félix M. Foreign bodies in the airway: a quarter of a century's experience. Rev Port Pneumol 2008;14:787-802.
• Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC. Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment. J Bras Pneumol 2008;34:74-82.
• Sinha V, Memon R, Gupta D, Prajapati B, Bhat V, More Y. Foreign body in tracheobronchial tree. Indian J Otolaryngol Head Neck Surg 2007;59:211-4.
• Saki N, Nikakhlagh S, Rahim F, Abshirini H. Foreign body aspirations in infancy: a 20-year experience. Int J Med Sci 2009;6:322-8.
• Findlay CA, Morrissey S, Paton JY. Subcutaneous emphysema secondary to foreign-body aspiration. Pediatr Pulmonol 2003;36:81-2.
• Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med 1984;144:1447-53.
• Saoji R, Ramchandra C, D'Cruz AJ. Subcutaneous emphysema: an unusual presentation of foreign body in the airway. J Pediatr Surg 1995;30:860-2.
• Paşaoğlu I, Doğan R, Demircin M, Hatipoğlu A, Bozer AY. Bronchoscopic removal of foreign bodies in children: retrospective analysis of 822 cases. Thorac Cardiovasc Surg 1991;39:95-8.
• Chung MK, Jeong HS, Ahn KM, Park SH, Cho JK, Son YI, et al. Pulmonary recovery after rigid bronchoscopic retrieval of airway foreign body. Laryngoscope 2007;117:303-7.