Significance of Preoperative Clinical and Radiological Assessment in Diagnosing Foreign Body Aspiration in Pediatric Patients


  • Rasha Nadeem Ahmed Dept. of Surgery, College of medicine, Ninevah University, Mosul, Iraq
  • Bassam Khaleel Al-abbasi Dept. of Surgery, College of medicine, Ninevah University, Mosul, Iraq
  • Nashwan M-Al Hafidh Dept. of paediatric, College of Medicine, Ninevah University, Mosul, Iraq


chest radiography, foreign body aspiration, bronchoscopy, pediatric FB aspiration


Background: Foreign Body Aspiration (FBA) poses a substantial worldwide health issue, with the
highest incidence observed among young children, Detecting and managing FBA promptly are crucial
to prevent potential complication.
Objectives: To evaluate the significance of preoperative clinical and radiological assessment in
diagnosing FBA in comparison with results of rigid bronchoscopy(RB).
Patients and Methods: A cross-sectional study was carried out in Nineveh province, Iraq, spanning
a period of 10 months from April 2018 to February 2019. The study focused on patients of pediatric
age group who were admitted with suspicion of FBA to Al-Khansaa Teaching Hospital in Nineveh
province. The cases who were included are under the age of 14 and had confirmed FBA through rigid
bronchoscopy (RB).
Results: Out of forty-four patient, 25 (56.8 %) were males, the average patients age was 4.8 years
with a standard deviation of 3.4 years. More than half of cases (54.5%) presented within the first 24
hours after onset of suspected FBA. The most common clinical presentation is the witnessed FBA
(93%) (41/44), followed by symptoms like chocking (34%), cough (23%), shortness of breath (11%)
and cyanosis (11%). Diminished air entry was the most frequently observed findings in clinical exam
(48%), followed by rhonchi in (36%) of cases. The primary CR findings were consolidation in 25%
and normal CR in another 25%. Radiopaque FB was successfully identified in CR of seven cases
(15.9%) only. Thus, the estimated sensitivity of CR in detecting FB by using RB as gold standard test
was 15.9%. Significantly, normal CR were more frequently observed in cases of early presentation.
Among the identified FBs, 63.6% were found to be of organic type, while 36.4% were of non-organic
type. The sunflower seeds found to represent most frequently encountered FB (34 %). Regarding site
of dislodgement of FB, 40.9% of FB were found in the right main bronchus (RMB) and 36.4% were
found in he left main bronchus (LMB).
Conclusion: A chest radiograph serves as a valuable asset for pediatric FBA diagnosis. However, its
value is optimized when combined with the clinical context to enhance accuracy. Notably, the
occurrence of false-negative chest X-rays is significantly linked to early presentations


Ayed AK, Jafar AM, Owayed A. Foreign body aspiration in children: diagnosis and treatment. Pediatric surgery

international. 2003 Aug 1;19(6):485-8.

Sahadan DZ, Zainudin NM, Kassim A, Zahari Z, Mahadzir M, Daud CZ, Mohammad N. Case series of foreign body

aspiration in Paediatric Institute, Hospital Kuala Lumpur. The Medical journal of Malaysia. 2011 Dec;66(5):484-6.

Hitter A, Hullo E, Durand C, Righini CA. Diagnostic value of various investigations in children with suspected foreign

body aspiration. European annals of otorhinolaryngology, head and neck diseases. 2011 Nov 1;128(5):248-52.

Nsaif HS, Laftah RF. Chest X-Ray findings of foreign body aspiration and their relation with type and site of impaction.

Journal of University of Babylon. 2015;23(2):862-9.

Sattar A, Ahmad I, Javed AM, Anjum S. Diagnostic accuracy of chest x-ray in tracheobronchial foreign body aspiration

in paediatric patients. Journal of Ayub Medical College Abbottabad. 2011 Dec 1;23(4):103-5.

Parida PK, Shanmugasundaram N, Gopalakrishnan S. Clinico-radiological parameters predicting early diagnosis of

foreign body aspiration in children. Kulak Burun Bogaz Ihtis Derg. 2016;26(5):268-75.

Silva AB, Muntz HR, Clary R. Utility of conventional radiography in the diagnosis and management of pediatric airway

foreign bodies. Annals of Otology, Rhinology and Laryngology. 1998 Oct;107(10):834-8.

Oliveira CF, Almeida JF, Troster EJ, Vaz FA. Complications of tracheobronchial foreign body aspiration in children:

report of 5 cases and review of the literature. Revista do Hospital das Clínicas. 2002 Jun;57(3):108-11.

Girardi G, Contador AM, Castro‐Rodríguez JA. Two new radiological findings to improve the diagnosis of bronchial

foreign‐body aspiration in children. Pediatric pulmonology. 2004 Sep;38(3):261-4.

Tokar B, Ozkan R, Ilhan H. Tracheobronchial foreign bodies in children: importance of accurate history and plain chest

radiography in delayed presentation. Clinical radiology. 2004 Jul 1;59(7):609-15.

Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: A critical review for a common pediatric emergency.

World journal of emergency medicine. 2016;7(1):5.

Kwok MM, Wong A, Paddle P, Goergen S, Rimmer J. Clinico-radiological predictors of positive rigid bronchoscopy

findings in children with suspected tracheobronchial foreign body aspiration. Australian Journal of Otolaryngology. 2018

Feb 27;1(2).

Bhalodiya N, Supriya M, Patel S. Foreign body aspiration in children: Decisive factors for carrying out bronchoscopy.

Indian Journal of Otolaryngology and Head and Neck Surgery. 2006 Oct 1;58(4):337-9.

Berraies A, Snen H, Hamdi B, Ammar J, Mestiri T, Kilani T, Hamzoui A. Foreign Body Aspiration in Tunisian Children:

Experience of a Paediatric Respiratory Diseases Department. Advances in Paediatric Research. 2015;2:17

Saquib Mallick M, Rauf Khan A, Al-Bassam A. Late presentation of tracheobronchial foreign body aspiration in

children. Journal of tropical pediatrics. 2005 Jun 1;51(3):145-8

Sahin A, Meteroglu F, Eren S, Celik Y. Aspiration of foreign bodies in children: experience of 22 years. Journal of

Trauma and Acute Care Surgery. 2013 Feb 1;74(2):658-63.

Rizk N, Gwely NE, Biron VL, Hamza U. Metallic hairpin inhalation: a healthcare problem facing young Muslim

females. Journal of Otolaryngology-Head and Neck Surgery. 2014 Dec;43(1):21.

Mu L, Sun D, He P. Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases. The Journal of

Laryngology and Otology. 1990 Oct;104(10):778-82