Pinto A, Scaglione M, Pinto F, Guidi G, Pepe M, Del Prato B, Grassi R, Romano L
Unità Operativa a Struttura Complessa di Radiologia Generale e di Pronto Soccorso, Dipartimento di Diagnostica per Immagini Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli, Italy.
Radiol Med. 2006 Jun;111(4):497-506. doi: 10.1007/s11547-006-0045-0. Epub 2006 May 25.
The purpose of this study was to determine the role of plain chest radiography in the evaluation of patients with suspected foreign-body aspiration.
During a 5-year period, 31 patients (18 men and 13 women; age range 6 months to 85 years) were referred to our observation for clinical suspicion of foreign-body aspiration. Clinically, the patients presented with cough in 27/31 cases (87.1%), decreased breath sounds in 22/31 (71%), choking in 18/31 (58.1%), fever in 7/31 (22.6%) and cyanosis in 5/31 (16.1%). Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. Within 2 h of hospitalisation, all patients underwent plain chest radiography performed in the upright position (two projections) in 10/31 (32.3%) patients and in the supine decubitus position in the remaining 21 (67.7%) patients. Plain chest radiography was subsequently integrated with multislice computed tomography (MSCT) of the chest in 3/31 (9.7%) patients and with bronchoscopy in 27/31 (87.1%) patients.
Plain chest radiography showed the presence of a foreign body in the tracheobronchial tree in 7/31 (22.6%) patients, who subsequently underwent successful bronchoscopy in all cases. Foreign bodies included tooth fragment (three cases), nail (two cases), metallic spiral of a ball-point pen (one case) and an earring (one case). In the remaining 24/31 patients, plain chest radiography was positive in 14 cases, showing atelectasis (seven cases), pneumonia (six cases), pulmonary hyperinflation (one case) and pneumomediastinum (one case). Such findings had been caused by an aspirated foreign body, which was subsequently removed by means of bronchoscopy in all 14 patients. Moreover, three of the remaining ten patients with negative plain chest radiograph were submitted to MSCT of the chest, which required in 1 case tracheobronchial aspiration of a foreign body that was subsequently removed by means of bronchoscopy. Overall, plain chest radiography showed the presence of foreign-body aspiration and/or pleuroparenchymal lesions in 21/31 patients (67.7%); bronchoscopy was positive in 23/27 patients (85.2%), localising the foreign body in the right main bronchus in 16/27 patients (59.3%), left main bronchus in 7/27 patients (25.9%), intermediate bronchus in 2/27 patients (7.4%) and right lower lobe bronchus in 2/27 patients (7.4%). No late complications were observed within 6 months of hospital discharge.
Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Nevertheless, in the case of negative chest radiography and a clinical suspicion of foreign-body aspiration, MSCT-possibly integrated with virtual bronchoscopy-should be considered in order to avoid unnecessary bronchoscopy.
本研究的目的是确定胸部平片在疑似异物吸入患者评估中的作用。
在5年期间，31例患者（18例男性和13例女性；年龄范围6个月至85岁）因临床怀疑异物吸入被转诊至我院观察。临床上，27/31例（87.1%）患者出现咳嗽，22/31例（71%）呼吸音减弱，18/31例（58.1%）有呛噎，7/31例（22.6%）发热，5/31例（16.1%）发绀。疑似异物吸入发生在入院前2 - 72小时。入院后2小时内，10/31例（32.3%）患者在直立位（两个投照位）进行了胸部平片检查，其余21例（67.7%）患者在仰卧位进行了胸部平片检查。随后，3/31例（9.7%）患者的胸部平片与胸部多层螺旋CT（MSCT）相结合，27/31例（87.1%）患者与支气管镜检查相结合。
胸部平片显示7/31例（22.6%）患者气管支气管树内有异物，所有这些患者随后均成功进行了支气管镜检查。异物包括牙齿碎片（3例）、指甲（2例）、圆珠笔金属螺旋（1例）和耳环（1例）。其余24/31例患者中，胸部平片阳性14例，表现为肺不张（7例）、肺炎（6例）、肺过度充气（1例）和气纵隔（1例）。这些表现均由吸入异物引起，随后所有14例患者均通过支气管镜取出异物。此外，其余10例胸部平片阴性的患者中有3例接受了胸部MSCT检查，其中1例需要进行气管支气管异物吸出，随后通过支气管镜取出异物。总体而言，胸部平片显示21/31例（67.7%）患者存在异物吸入和/或胸膜实质病变；支气管镜检查23/27例（85.2%）为阳性，其中16/27例（59.3%）异物位于右主支气管，7/27例（25.9%）位于左主支气管，2/27例（7.4%）位于中间支气管，2/27例（7.4%）位于右下叶支气管。出院后6个月内未观察到晚期并发症。
胸部平片仍然是临床怀疑气管支气管异物吸入患者的初始影像学检查方法。然而，对于胸部平片阴性但临床怀疑异物吸入的病例，应考虑进行MSCT检查（可能与虚拟支气管镜检查相结合），以避免不必要的支气管镜检查。
