The value of lung scintigraphy in the management of airways foreign bodies in children

• Published in: Minerva pediatrica Vol. 61; no. 5; p. 477
• Main Authors: Guanà, R, Gesmundo, R, Maiullari, E, Bianco, E R, Vinardi, S, Cortese, M G, Silvestro, L, Canavese, F
• Format: Journal Article
• Language: English; Italian
• Published: Italy 01-10-2009
• Subjects: Adolescent; Algorithms; Anesthesia, General; Bronchi; Bronchoscopes; Bronchoscopy; Child, Preschool; Female; Foreign Bodies - diagnosis; Foreign Bodies - diagnostic imaging; Foreign Bodies - therapy; Humans; Infant; Lung - diagnostic imaging; Male; Radiography; Radionuclide Imaging; Retrospective Studies; Time Factors; Trachea; Treatment Outcome
• ISSN: 0026-4946

A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age <or= 14 years), underlining the importance of lung scintigraphy in patients' selection.
The authors retrospectively reviewed all pediatric bronchoscopies performed by the bronchoscopic team at their Institution from July 2001 to December 2007 in the suspicion of TFB in children <14 years of age.
A total of 32 TFB were identified in 25 boys and 7 girls with a mean age of 2.7 years (range, 6 months to 13 years). Diagnostic algorithm included: historical data, clinical evaluation, X-rays and nuclear medicine imaging. Bronchoscopy was performed under general anesthesia only in scintigraphy positive patients. In the procedure, a 2.7 mm pediatric flexible bronchoscope, passed through the endotracheal tube, was used exclusively for demonstrate and localize TFB and a 3.5-4 mm rigid bronchoscope to extract it. Extraction with the rigid bronchoscope was successful in all cases. The average time of the procedure using both instruments was 46 min (range 35 to 200 minutes). There were no complications associated with any of the procedures in these children.
Rigid bronchoscopic extraction of paediatric TFB can be performed safely with minimal risks and complications. Careful patient's' selection remains crucial for choosing candidates to bronchoscopy. In our experience scintigraphic evaluation demonstrated to be of great value in order to have a correct pre-endoscopic diagnosis.