Guglielmo Robert D, Khemani Robinder G
Division of Pediatric Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles (CHLA), Keck School of Medicine of the University of Southern California (USC), Los Angeles, CA, USA.
Case Rep Pediatr. 2021 Nov 2;2021:9951838. doi: 10.1155/2021/9951838. eCollection 2021.
Foreign body aspiration (FBA) in children has a high morbidity, and early diagnosis is the key for preventing acute and chronic respiratory complications. To diagnose FBA, commonly used imaging modalities have limited negative predictive value, and rigid bronchoscopy remains as the gold standard. We present a case where the diagnosis of FBA was made in a novel way with electrical impedance tomography (EIT). . A 19-month-old previously healthy boy was admitted with a clinical diagnosis of respiratory failure secondary to bronchiolitis. Chest X-ray showed bilateral lung hyperinflation. He enrolled in a research study which used EIT to measure the effects of high flow nasal cannula (HFNC) on minute ventilation in children with bronchiolitis. On initiation, the patient had near-normal right lung ventilation (98%) and near-absent left lung ventilation (2%). We discontinued the study and alerted the medical team that we suspected FBA. Further imaging (lateral decubitus films and lung ultrasounds) was also obtained, but was not diagnostic. Rigid bronchoscopy was performed and showed a peanut occluding the left mainstem bronchus (LMB). The peanut was removed followed by complete resolution of the patient's symptoms.
We believe this is the first reported case of FBA diagnosed via EIT. EIT has been shown to be a useful but underutilized technology for diagnosing respiratory disease. While FBA remains a relatively common cause of morbidity and mortality in children less than age four, early diagnosis remains difficult and requires vigilance. This case illustrates the challenges of relying on chest films and ultrasound to assist with diagnosis and suggests that EIT in combination with a thorough history and physical exam can be used to confirm the presence of FBA.
儿童异物吸入（FBA）发病率高，早期诊断是预防急慢性呼吸并发症的关键。对于FBA的诊断，常用的影像学检查方法阴性预测价值有限，硬支气管镜检查仍是金标准。我们报告一例通过电阻抗断层成像（EIT）以新颖方式诊断FBA的病例。一名19个月大、既往健康的男孩因临床诊断为细支气管炎继发呼吸衰竭入院。胸部X线显示双侧肺过度充气。他参加了一项研究，该研究使用EIT测量高流量鼻导管（HFNC）对细支气管炎患儿分钟通气量的影响。开始时，患者右肺通气接近正常（98%），左肺通气几乎消失（2%）。我们中断了研究，并告知医疗团队我们怀疑有FBA。还进行了进一步的影像学检查（侧卧位胸片和肺部超声），但未明确诊断。进行了硬支气管镜检查，发现一颗花生阻塞了左主支气管（LMB）。取出花生后，患者症状完全缓解。
我们认为这是首例通过EIT诊断FBA的报道病例。EIT已被证明是一种有用但未得到充分利用的诊断呼吸系统疾病的技术。虽然FBA仍然是4岁以下儿童发病和死亡的相对常见原因，但早期诊断仍然困难，需要保持警惕。该病例说明了依靠胸片和超声辅助诊断的挑战，并表明EIT结合详细的病史和体格检查可用于确诊FBA。
