Skip to main content

Role of virtual bronchoscopy in foreign body inhalation in children




To investigate the usefulness of three-dimensional images on the basis of multidetector computer tomography (MDCT) in the evaluation of suspected foreign body (FB) aspiration in children.

Patients and methods

A total of 28 children presented to Ain Shams University hospital with suspected FB inhalation. All patients underwent chest radiographs. Of the patients, eight with inconclusive history, physical examination, and negative radiograph findings for FB inhalation underwent MDCT. All patients underwent rigid bronchoscopy (RB) and the results were compared with the findings of chest radiographs and virtual bronchoscopy images.


Four patients were negative by radiography and MDCT scan, and were subjected to RB, with no FB found. The other four patients who were negative by radiography turned out to be positive by MDCT and were subjected to RB, which was positive for FB in only 3 patients. MDCT had a negative predictive value of 100%, whereas its positive predictive value was 75%.


RB should always be performed as a first-line procedure in the presence of a combination of characteristic clinical and radiographic signs. In the other patients, the presence of FB can be confirmed by MDCT in order to reduce the negative RB rate.


  1. Zhijun C, Fugao Z, Niankai Z, Jingjing C. Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body. J Pediatr Surg 2008;43:718–721.

    Article  Google Scholar 

  2. Kiyan G, Gocmen B, Tugtepe H, Karakoc F, Dagli E, Dagli TE. Foreign body aspiration in children: the value of diagnostic criteria. Int J Pediatr Otorhinolaryngol 2009;73:963–967.

    Article  Google Scholar 

  3. Zaytoun GM, Rouadi PW, Baki DH. Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications. Otolaryngol Head Neck Surg 2000;123:311–316.

    Article  CAS  Google Scholar 

  4. Hong SJ, Goo HW, Roh JL. Utility of spiral and cine CT scans in pediatric patients suspected of aspirating radiolucent foreign bodies. Otolaryngol Head Neck Surg 2008;138:576–580.

    Article  Google Scholar 

  5. Cataneo AJ, Cataneo DC, Ruiz RL Jr. Management of tracheobronchial foreign body in children. Pediatr Surg Int 2008;24:151–156.

    Article  Google Scholar 

  6. Torres de Amorim e Silva CJ, Fink AM. Case 137: pneumonia and bronchiectasis secondary to unrecognized peanut impaction. Radiology 2008;248:1080–1082.

    Article  Google Scholar 

  7. Jacob SS, Jacob JJ, Paul TV. Foreign body aspiration in a boy with Prader–Willi Syndrome. Singapore Med J 2008;49:e12–e14.

    CAS  PubMed  Google Scholar 

  8. Reilly J, Thompson J, MacArthur C, Pransky S, Beste D, Smith M, et al. Pediatric aerodigestive foreign body injuries are complications related to timeliness of diagnosis. Laryngoscope 1997;107:17–20.

    Article  CAS  Google Scholar 

  9. Chiu CY, Wong KS, Lai SH, Hsia SH, Wu CT. Factors predicting early diagnosis of foreign body aspiration in children. Pediatr Emerg Care 2005;21:161–164.

    PubMed  Google Scholar 

  10. Tan HK, Brown K, McGill T, Kenna MA, Lund DP, Healy GB. Airway foreign bodies (FB): a 10-year review. Int J Pediatr Otorhinolaryngol 2000;56:91–99.

    Article  CAS  Google Scholar 

  11. Paterson A, Frush DP. Dose reduction in paediatric MDCT: general principles. Clin Radiol 2007;62:507–517.

    Article  CAS  Google Scholar 

  12. Cevizci N, Dokucu AI, Baskin D, Karadağ CA, Sever N, Yalçin M. Virtual bronchoscopy as a dynamic modality in the diagnosis and treatment of suspected foreign body aspiration. Eur J Pediatr Surg 2008;18:398–401.

    Article  CAS  Google Scholar 

  13. Gang W, Zhengxia P, Hongbo L, Yonggang L, Jiangtao D, Shengde W, et al. Diagnosis and treatment of tracheobronchial foreign bodies in 1024 children. J Pediatr Surg 2012;47:2004–2010.

    Article  Google Scholar 

  14. Haliloglu M, Ciftci AO, Oto A, Gumus B, Tanyel FC, Senocak ME, et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol 2003;48:188–192.

    Article  Google Scholar 

  15. Tong B, Zhang L, Fang R, Sha Y, Chi F. 3D images based on MDCT in evaluation of patients with suspected foreign body aspiration. Eur Arch Otorhinolaryngol 2013;270:1001–1007.

    Article  Google Scholar 

  16. Bhat KV, Hegde JS, Nagalotimath US, Patil GC. Evaluation of computed tomography virtual bronchoscopy in paediatric tracheobronchial foreign body aspiration. J Laryngol Otol 2010;124:875–879.

    Article  CAS  Google Scholar 

  17. Kocaoglu M, Bulakbasi N, Soylu K, Demirbag S, Tayfun C, Somuncu I. Thin-section axial multidetector computed tomography and multiplanar reformatted imaging of children with suspected foreign-body aspiration: Is virtual bronchoscopy overemphasized? Acta Radiol 2006;47:746–751.

    Article  CAS  Google Scholar 

  18. Louie MC, Bradin S. Foreign body ingestion and aspiration. Pediatr Rev 2009;30:295–301.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tamer A. Youssef MD.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hassan, M.A., Youssef, T.A. & El-Gharib, M. Role of virtual bronchoscopy in foreign body inhalation in children. Egypt J Otolaryngol 29, 249–253 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: