Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge

Abstract

Background: Foreign body aspiration (FBA) is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis.

Patients and Methods: This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient’s characteristics, history, clinical, radiographic, bronchoscopic findings, reason for delay presentation, and complications were noted.

Results: A total of 158 children admitted to the hospital with suspected FBA were included in this study. The average age was 3.28 years. Fortyeight (30.3%) children were presented late (more than 14 days after FBA) and 110 (69.7%) children were presented early (0–14 days). The common clinical manifestations of FBA were persistent cough (100%) and choking (72%). The most frequent radiological finding observed was air trapping (40%) followed by atelectasis (14%). Chest radiographs were normal in 32.2% patients. Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%). Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts accounted for 80% of the aspiration.

Conclusion: FBA is diffi cult to diagnose in children. Delay in diagnosis appears to result from a failure to give serious consideration to the diagnosis. Early diagnosis and removal of foreign bodies must be achieved to avoid complications.

Key words: Aspiration, bronchoscopy, complications, foreign bodies, signs and symptoms