Role of X-Ray in Managing Foreign Body Aspiration in Children

Objective: This study’s primary objective was to determine the predictive value and clinical significance of chest X-ray in diagnosing foreign body aspiration (FBA) in children. In addition, demographic, clinical, radiological, and bronchoscopic findings were evaluated. Methods: This retrospective study included 203 children (0-18 years of age) admitted to the hospital with suspected FBA during 2013 to 2023. Patients’ data were evaluated in terms of age, gender, symptoms, radiological findings, bronchoscopic findings, length of hospital stay, period of presence of foreign bodies (FBs), and post-procedural complications. Results: FBA was confirmed in 52.2% (n = 106) of the children, the majority (76.4%) of cases occurring in children aged 0 to 3 years. Symptoms most frequently reported presenting were cough (63.0%), wheezing (25.1%), vomiting (24.6%), choking (23.2%), fever (11.0%), stridor (9.4%), and cyanosis (6.4%). Chest radiographs revealed pathological findings in 62.1%, most commonly being prominent bronchovascular markings (50.4%), hyperinflation (15.2%), reduced transparency (15.2%), and visible radiopaque FBs (3.2%). Auscultation was abnormal in 65.0% of cases, with wheezing, diminished breath sounds, and crackles found most frequently. Although both auscultation and X-ray findings are independently associated with FB detection, auscultation demonstrates stronger predictive value. Bronchoscopy identified the right bronchial tree as the most frequent location of FBs (47.2%), with nuts being the item most commonly retrieved (51.9%). Conclusions: This study highlights the value of chest X-ray in combination with clinical signs. While auscultation alone is more predictive, using both improves diagnostic accuracy. A structured approach with clinical exam, imaging, and timely bronchoscopy is essential for optimal outcomes.