Validity of Chest X-Ray in the Diagnosis of Airway Foreign Body; Analysis of 112 Cases

Abstract

Objective: To find out the validity of chest x-ray (CXR) in patients suspected of foreign body (FB) aspiration in our population considering bronchoscopy and/or thoracotomy as gold standards.

Study Design: A prospective validation study.

Place and Duration of Study: Departments of thoracic surgery, otorhinolaryngology, and diagnostic radiology from Combined Military Hospitals of Rawalpindi, Lahore, Malir, and Quetta and Pakistan Naval Ship Shifa, Karachi Pakistan, from Aug 2006 to Nov 2017.

Methodology: We included consecutive patients who underwent bronchoscopy and/or thoracotomy for suspected FB aspiration and recorded the findings observed on bronchoscopy and/or thoracotomy. The available radiological data pertinent to all included patients were recovered from the patients and the respective radiological departments. The CXRs were carried out in poster anterior or anteroposterior and lateral views and reviewed by consultant radiologists. All bronchoscopies were done using Karl Storz Ventilating Bronchoscopes.

Results: Out of 112 patients with FB aspiration, (mean age: 6 ± 7 years, range 1-45 years), 77 (68.8%) cases were male and 35 (31.3%) were females. Chest x-rays were normal in 27(24.1%) cases, while in 85 (75.9%) cases, a direct or indirect evidence of FB aspiration was observed. The commonest radiological finding was a radiopaque FB in 31(27.7%) cases. The sensitivity of CXR was 76.4%, while specificity was 50%, with positive predictive value of 98.8%, and negative predictive value of 3.7%. The accuracy rate was 76%.

Conclusion: Chest x-ray is a good screening tool for the diagnosis of airway FB but a normal CXR does not always rule out FB aspiration in patients with a positive clinical evaluation.