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CT in Children With Suspected Residual Foreign Body in Airway After Bronchoscopy

¹ All authors: Department of Radiology, Seoul National University College of Medicine and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.

OBJECTIVE. The purpose of our study was to determine whether CT provides additional information for children with a suspected residual foreign body in the airway after bronchoscopy.

MATERIALS AND METHODS. We reviewed the CT findings and medical records of nine patients (five girls and four boys; mean age, 17.9 months) who underwent CT between March 1999 and February 2007 for the evaluation of a clinically suspected residual foreign body in the airway after bronchoscopy. We evaluated the location and pattern of bronchial obstruction and associated parenchymal abnormalities on CT. CT findings were compared with a second bronchoscopy in five patients. The remaining four patients were followed clinically. Association between CT findings and results on second bronchoscopy was evaluated with Fisher's exact test.

RESULTS. CT after bronchoscopy (n = 9) showed bronchial obstruction in eight patients with focal complete (n = 3), diffuse (n = 3), or combined type (n = 2) bronchial obstruction. These obstructions were not seen at chest radiography. CT revealed unilateral or lobar emphysema (n = 6), atelectasis (n = 6), and consolidation (n = 1). The remaining one patient showed no abnormality on CT. A second bronchoscopy (n = 5) confirmed the focal complete bronchial obstruction at CT (n = 3) as retained foreign body fragments (n = 2) or mucus plug (n = 1) and the combined type at CT (n = 2) as retained foreign body fragments, granulation tissue, and edema of the bronchus (n = 1) or retained foreign body fragments, granulation tissue, and mucus plug (n = 1). There was a significant association between CT findings of type of bronchial obstruction and intrabronchial obstructive lesion on the second bronchoscopy (p = 0.036).

CONCLUSION. CT after bronchoscopy can provide additional information regarding the presence and pattern of bronchial obstruction in children with a suspected residual foreign body.

Keywords: atelectasis • bronchoscopy • CT • emphysema • foreign body • tracheobronchial tree

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