الفهرس 
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Abstract
Foreign body aspiration continues to be a diagnostic and therapeutic challenge. The aims of the present study were to determine the accuracy and reliability of the clinical signs and correlating them to the rigid bronchoscopy and imaging findings in order to reach the optimum criteria that will enable us in the future to avoid unnecessary bronchoscopy and increase the rate of positive bronchoscopies and to reduce the drawbacks of rigid bronchoscopy, including its invasiveness and the potential for exacerbation of reactive airway disease.
This cross-sectional study included 50 patients diagnosed with suspected foreign body inhalation. They were recruited and assessed for eligibility from Otorhinolaryngology Department, Beni-Suef University Hospital.
The study showed the following findings:
• Regarding the demographic characteristics of the studied cases, our results revealed that the mean age of patients was 3.896±0.197 years old, ranging between 1-15 years old. 52% was females and 48% was males.
• Regarding the site of impaction of the aspirated foreign bodies among all patients, our results revealed that trachea was the site of foreign body impaction in 34% of cases followed by the right main bronchus (32%) and left main bronchi (28%), followed by subglottic area, carina down to right main bronchus, and distal part of Trachea (2% each).
• Regarding time needed to seek medical advice among all patients, our results revealed that 72% of patients seek medical advice in the same day following foreign body aspiration. 4% after one day and 2% seek medical advice after each of 3 days, 14 days and 20 days following foreign body aspiration. 8% seek medical advice after two day. 4% and 6% seek medical advice after 5 days and 7 days respectively.
• Regarding the imaging comment among all patients, our results revealed that 4% of patients have normal CT, 18% of patients showed metallic object, 24% have emphysematous changes, 12% have pneumonia, and 14% have lung collapse.
• Our results revealed that foreign body shadow occur in 88% of cases and 4% were highly suspected. Pleural Effusion presented in 6% of patients.
• The study revealed that suspected FB shadow in CT-scans has high sensitivity and specificity of 95.12% and 80% respectively. Pneumoina and lung collapse have high specificity but with low sensitivity.
• Regarding clinical presentation of patients, our results revealed that 82% of patients have wheezes, 72% have cough, and 62% witnessed aspiration and chocking and (64%) have unequal air entry (diminished air entry). 62% of patients have dyspnea, 24% have crepitation, 14% have stridor, 10% have aphonia and 4% have respiratory arrest.
• Four cardinal presentations (cough, chocking, diminished breath sound and dyspnea) have high sensitivity, specificity and PPV. Localized wheezes have high sensitivity and PPV; however, they have low specificity level.
• Regarding type of retrieved object among all patients, our results revealed that 56% were exogenous foreign body (Vegetable), 34% were exogenous foreign body (non-vegetable). 4% of patients have endogenous foreign body such as blood, mucus, and secretions. No retrieved objects occur in 6% of cases.
• Our results revealed that successful retrieval among all patients occur in 96% of cases, however, no successful retrieval in 4% of cases. Regarding the incidence of complications among all patients, our results revealed that 10% of patients have complications and most cases (90%) showed no complications. Please note that manual jet ventilation anesthetic technique decrease the risk of intraoperative hypoxemia.
• Regarding the hospital stay in days among all patients, our results revealed that 64% of cases stayed one day, 28% stayed two days, 4% of cases stayed three days. 2 of cases stayed ten days and 2% of cases stayed fourteen days.
• It is worth mentioning that, additional observation (longer hospital stay) required for younger children to ensure full recovery with no evidence of complication. Extra caution is also required, especially in aspiration of organic material for late onset complications, such as pneumonia.
• The optimum criteria that we should go for in handling with FBA could be seen in the following algorithm
A moderate or high suspicion of foreign body aspiration includes all children with a witnessed FBA (regardless of symptoms), and those with suggestive respiratory symptoms or suspicious characteristics on imaging, especially if there is a history of choking.
Δ For stable patients with a high clinical suspicion of aspiration, it is reasonable to proceed directly to bronchoscopy, even if the plain radiographs are normal or inconclusive. Alternatively, computed tomography (CT) can be performed first to help clarify the diagnosis (dotted line), if the provider judges that negative imaging would be sufficient to preclude bronchoscopy.
◊ Rigid bronchoscopy is the procedure of choice to remove a foreign body. In cases where the diagnosis or location of the foreign body is unclear, it is usually preferable to perform flexible bronchoscopy first, then proceed to rigid bronchoscopy for foreign body removal.Some advocates for an MDCT with virtual bronchoscopy, if available, or an MRI especially in radiolucent FB (e.g peanut).