A 36-Year-Old Woman with Cough, Dyspnea and Pulmonary Infiltration

Tracheobronchial foreign body (TFB) aspiration is a common cause of mortality and morbidity in early childhood. The aim of this study was to evaluate the diagnostic value of chest x-ray in tracheobronchial foreign body aspiration among a group of Iranian children. We evaluated 32 children who underwent bronchoscopy for suspected airway foreign bodies. We reviewed the patients'' age, symptoms, duration of symptoms, prebronchoscopy posterior-anterior x-rays, type of foreign body, and anatomic location of foreign body. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy indices of chest x-ray for the diagnosis of TFB aspiration were measured in this study. The mean age of patients was 30 months (range 6–54 months), and 19(59.4%) were males. Among 32 patients who underwent bronchoscopy, foreign body was found and removed in 26 (81.2%) of them. Foreign bodies observed were the hull of nuts in 10 (38.5%), pomegranate seeds in 6 (23%), beans in 4 (15.4%), and some food products such as meat in two (7.7%) children. Chest x-ray was normal in 12 patients (37.5%). The most common symptom was cough in 80% of patients; followed by wheezing in 60%, tachypnea in 40%, dyspnea in 20%, and stridor in 5%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of expiratory chest radiography in this study were 65%, 50%, 85%, 25%, and 62.5%, respectively. Chest x-ray is not specific for diagnosis of foreign body aspiration, and a normal chest x-ray does not always rule out the diagnosis of foreign body aspiration in patients with a history suggestive of foreign body aspiration and positive physical examinations. (