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Clinical evaluation for bronchoscopic management in pediatric patients suspected to have foreign body inhalation.

Fawaz Mahmood Mustaf Alfaqe*, Bassam Khaleel Al-Abbasi

Background: Tracheobronchial foreign body aspiration in pediatric is a life-threatening condition, the early diagnosis and treatment are crucial to prevent complications. Patients and Methods: 51 patients younger than 14 years, were studied in Al-Khanssa teaching hospital, according to their age, sex, time of presentation, history of foreign body aspiration, clinical, radiological as well as bronchoscopic findings. Results: In 51 patients (27 males, 24 females), mean age 4.3 years, largest portion presented within first 24 hour of FB aspiration (43%), positive history was noted in 84.3%, with PPV of 95.5%, NPV of 85.7%, most common clinical presentations were dyspnea (68.6%) and cough (64.7%),most common finding in clinical examination was rhonchi (47.1%), the consolidation was the most common CXR findings(35.3%), negative CXR noted in 29.4%, most commonly encountered FB is organic materials (54.9%), mainly food, Right Main Bronchus (RMB) is the most common site of FB impaction (35.3%) followed by Left Main Bronchus (LMB) (31.4%), then trachea (9.8%), Rigid Bronchoscopy (RB) was done urgently in most of the cases (78%), additional procedures are needed in limited number of cases and they included esophagoscopy and thoracotomy, no mortality or morbidity were recorded after RB. Conclusion: Positive history of inhalation is most important indicator of TFBA, clinical findings can aware doctor for possibility of TFBA especially in toddlers, however none of clinical findings are specific, the most specific Chest X-Ray finding (CXR) is detection of radiopaque FB, however this is uncommon finding, hence most common aspirated FB are organic radiolucent materials, negative CXR cannot exclude TFBA, especially when history and clinical findings are suggestive, the rigid bronchoscopy, remains the gold standard in the management of TFBA.