Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children

Objectives: Most tracheobronchial foreign bodies in children are radiolucen t, and accurate diagnosis of such foreign bodies is not always easy. This c an result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoro scopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. Me thods: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from I I months to 4 years and 7 months in age (mean 1.8 +/-0.9 ye ars)) who were suspected to have radiolucent aspirated foreign bodies. Sinc e DSF revealed abnormal findings in a trachea or main bronchus in IS cases, inspection was performed for foreign body bronchofiberscopically. In the o ne remaining case, no abnormality was recognized on DSF, but since the symp toms at the time of onset strongly suggested aspirated foreign body, bronch ofiberscopy was also performed. Results: Foreign body was verified bronchos copically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF , including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal ede ma in one case. All five patients (100%) had abnormal findings on DSF, incl uding obstruction of the bronchial lumen in four and indistinct visualizati on of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were not ed. Conclusions: DSF was very sensitive in the diagnosis of foreign body as piration and stenotic changes in the bronchial lumen. However, its diagnost ic specificity for aspirated foreign body itself was not high (17%). Theref ore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. W hen a foreign body is verified, rigid ventilation bronchoscopy is successiv ely performed to retrieve the foreign body. (C) 2001 Elsevier Science Irela nd Ltd. All rights reserved.