Bhat K V, Hegde J S, Nagalotimath U S, Patil G C
Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.
J Laryngol Otol. 2010 Aug;124(8):875-9. doi: 10.1017/S0022215110000769. Epub 2010 Apr 29.
Virtual bronchoscopy is a noninvasive technique which provides an intraluminal view of the tracheobronchial tree. This study aimed to evaluate this technique in comparison with rigid bronchoscopy, in paediatric patients with tracheobronchial foreign bodies undetected by plain chest radiography.
Plain chest radiography was initially performed in 40 children with suspected foreign body aspiration. Computed tomography virtual bronchoscopy was performed in the 20 in whom chest radiography appeared normal. Virtual bronchoscopic images were obtained. All patients underwent rigid bronchoscopy performed by an otolaryngologist blinded to the computed tomography virtual bronchoscopy findings, within 24 hours. Virtual bronchoscopic findings were then compared with the results of rigid bronchoscopy.
In 12 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. In one case, a mucous plug was perceived as a foreign body on virtual bronchoscopy. In another case, a minute foreign body was missed on virtual bronchoscopy. The following parameters were calculated: sensitivity, 92.3 per cent; specificity, 85.7 per cent; validity, 90 per cent; positive likelihood ratio, 6.45; and negative likelihood ratio, 0.089.
In the presence of a positive clinical diagnosis and negative chest radiography, computed tomography virtual bronchoscopy must be considered in all cases of tracheobronchial foreign body aspiration, in order to avoid needless rigid bronchoscopy. Computed tomography virtual bronchoscopy is particularly useful in screening cases of occult foreign body aspiration, as it has high sensitivity, specificity and validity.
虚拟支气管镜检查是一种提供气管支气管树腔内视图的非侵入性技术。本研究旨在将该技术与硬质支气管镜检查相比较，用于胸部X线平片未发现气管支气管异物的儿科患者。
对40例疑似异物吸入的儿童首先进行胸部X线平片检查。对胸部X线平片显示正常的20例患儿进行计算机断层扫描虚拟支气管镜检查，获取虚拟支气管镜图像。所有患者在24小时内由对计算机断层扫描虚拟支气管镜检查结果不知情的耳鼻喉科医生进行硬质支气管镜检查。然后将虚拟支气管镜检查结果与硬质支气管镜检查结果进行比较。
12例患者虚拟支气管镜检查发现的异物经硬质支气管镜检查得以证实。1例患者虚拟支气管镜检查时黏液栓被视为异物。另1例患者虚拟支气管镜检查遗漏了一个微小异物。计算了以下参数：敏感性92.3%；特异性85.7%；准确性90%；阳性似然比6.45；阴性似然比0.089。
在临床诊断为阳性而胸部X线平片为阴性的情况下，对于所有气管支气管异物吸入病例均应考虑进行计算机断层扫描虚拟支气管镜检查，以避免不必要的硬质支气管镜检查。计算机断层扫描虚拟支气管镜检查在隐匿性异物吸入病例的筛查中特别有用，因为它具有较高的敏感性、特异性和准确性。
