1. DIAGNOSIS OF FOREIGNBODY ASPIRATION IN CHILDREN BY AHMED Y. AL-AMMAR, MD,FKSU

2. FBA Annual incidence of death (500-2000) in USA Age 1-3 years Organic material are the most common

3. FBS Hx. Of FBA may be – clear 50% - less obvious 50% (challenging) 20-24% FBA are misdiagnosed

4. FBA Reliable indicators: - chocking – sudden onset coughing – unilateral wheeze - unilateral reduction of A/E – radiological finding of emphysema, atelectasis, FB

5. FBA OBJECTIVE To assess the diagnostic value of – symptoms – signs – radiological findings

6. FBA materials and methods Retrospective study of 39 children – bronchoscopy ( presumptive DX of FBA) KAUH Jan 1991 to Dec 2000 Based on bronchoscopy: - group A; (30 children) +ve FBA – group B; (9 children) – ve FBA

7. FBA materials and methods cont. Assessment of symptoms, signs, and radiological findings in each group Findings were compared in the two groups

8. FBA results Male 25 female 14 Mean age 28.5 mon. Time of presentation; A; mostly within 24 h. B; between 2 d. And 18 mon.

9. FBA result/ discussion Matching symptoms, signs and radiological finding does not lead to the DX most of time F.Oguz et al : found all the reliable indicators in only 23% Only 17% of our patients DX of FBA based on only one indicator is associated with other difficulties

10. Group B Percentage of affected children Group A Percentage of affected children Presenting symptom 3377 Choking 8087 Coughing 3343 Breathing difficulty 3330 Noisy breathing 1033 Cyanosis 1047 vomiting Table 1: shows the frequency of presenting symptoms

11. FBA R/D Coughing – high sensitivity 87% in our study – specificity 22%

12. FBA R/D Choking - sensitivity of 77% - specificity of 67% - both in agreement with Metrangolo HX; coughing and choking – sensitivity of 67% - specificity of 78%

13. FBS R/D Unilateral reduction of AE: - sensitivity 43% - specificity 78% (most specific) In 25%; no matching between reduction of AE and bronchoscopy findings

14. FBS R/D Wheezing; sensitivity of 63% specificity of 67% Exam (reduction of AE and wheezing) - sensitivity 17% - specificity 100% (far from reported specificity of the combined signs and symptoms 11.7)

15. FBA chest radiograph Especially insp. & exp films Lateral dequbitus Fluoroscopy Last two for uncooperative children

16. Group BGroup AX-ray finding 1 (11%)12 (40%) Normal 3 (33%)8 (27%) Emphysema* 03 (10%) Atelectasis* 05 (17%) Demonstration of FB* 02 (7% ) X-ray not done 3 (33%)0 Patchy infiltrate Table 2; demonstrates findings on chest X-ray * Match the location of FB by bronchoscopy

17. FBA chest radiograph Was done within few hours to 10 days Group A; abnormal 57%, normal 40% Group B; abnormal 89% Normal C-X-ray can be seen; - bronchial FBs; 7-32% - laryngotracheal FBs; 60-80% Should not preclude bronchoscopy

18. FBA chest radiograph Sensitivity; 57% (reported 70%) Specificity; 50% (reported 45-62%)

19. FBA chest radiograph Air-trapping – early – 65% (37% in our study) Atelectasis – more slowly – 25% (11% in our study) Radioopaque FBs – 5% (18% in our study) – laryngeal FBS were more easy to demonstrate - could be due to the size

20. SpecificitySensitivityCategory 78%67%History 100%17%Physical exam. 50%57%Chest radiograph Table 3; compare the diagnostic value of the different categories

21. FBA R/D Very important to take advantage of all diagnostic indicators Above all implement a high index of suspicion

22. FBA R/D To come with more reliable results and conclusions; - larger number of children – prospective study – clear protocol