Rukhsana Samad, Ghareeb Nawar, Zakirullah.
Role of clinical assessment and plain chest radiograph in the management of suspected Tracheobronchial foreign body.
J Surg Pak Jan ;13(3):99-102.

Objective: To determine the role of clinical and radiological assessment in patients with suspected foreign bodies (FB) of tracheobronchial tree. Study design: A comparative study. Place and duration of study: This study was conducted at Khyber Teaching Hospital Peshawar, from January 2003 to December 2004. Patients and Methods: A total of 124 patients were included in the study who underwent rigid bronchoscopy for suspected foreign body inhalation. Patients were clinically assessed for respiratory distress, chest excursion, air entry etc. All had chest radiograph to note baseline x ray findings. Those patients in whom foreign body found, were placed in group B and others in group A. The groups were then compared for various variables like demography, clinical features, clinical examination and radiological findings. Results: Ages of the patients ranged from two months to 10 years. But most of them (n 65) were between 1-3 years of age. More boys (n 72) were affected than girls, in a ratio of 3:2. The most common manifestations were cough, wheeze and decreased breath sounds. Chest x-ray revealed obstructive emphysema of the affected lung with mediastinum shift in majority of cases with foreign body aspiration. Children in whom no FB was found on bronchoscopy were mostly below one year of age and their main manifestations were fever and bilateral wheeze with radiological findings of atelectasis and pneumonia. Foreign bodies were found in 84 cases (group B). The FBs were mostly of vegetative origin like peanuts, beans, grams (n 74), while others were plastic objects and beads etc (n 10). FBs were removed in all but two cases who were referred to cardiothoracic unit for removal. Conclusions: Proper history taking and carrying out thorough physical examination with a high index of suspicion is crucial for early diagnosis of tracheobronchial foreign bodies. The presentation of acute airway problems like stridor, hoarseness of voice, cough etc are commonly seen in acute infections, particularly croup. Foreign body inhalation can present in the same way. The diagnosis may be missed unless a specific history of F.B inhalation is mentioned by the patients or parents, or it is specifically considered by the Physician. The condition is also over looked in case of delayed presentation. Thorough clinical approach combined with radiological assessment helps in early diagnosis.

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