Abstract

Introduction: Chest X-ray (CXR) is the primary imaging method for the diagnosis of foreign body (FB) aspiration (FBA) and the most common finding is ipsilateral hyperinflation due to air-trapping. FB related hyperinflation can be subtle and difficult to detect in the evaluation of the CXR. Radiodensity measurement of the lungs on CXR could be useful for the diagnosis of FBA. The aim of this study is to evaluate the diagnostic effectiveness of quantitative measurement of lung radiodensity in detecting hyperinflation on CXR of the patients with suspected FBA.

Methods: Records of patients who underwent rigid bronchoscopy for evaluation of FBA between January 2008 and June 2020 were reviewed retrospectively. Initial CXR of the patients were re-evaluated quantitatively by measuring lung radiodensity in FBA present and FBA absent groups.

Results: FB was detected in 154 patients, while FB was not detected in 87 patients during bronchoscopy. FB was in right lung in 89 patients, in left lung in 51 patients thus unilateral FB was present in 140 patients. Records of initial CXR evaluation of these 140 patients with unilateral FB showed unilateral lung hyperinflation in 60 patients (42.9%) and no unilateral hyperinflation in 80 patients (57.1%). Lung radiodensities of the FB present lungs were statistically significantly less dense compared with radiodensities of the contralateral lungs. A 5.5% or more lung radiodensity difference compatible with hyperinflation were found in 113 out of 140 patients (80.7%) with unilateral FB during lung radiodensity measurements. During the initial CXR evaluation, the hyperinflation detection rate was 42.9%, with the lung radiodensity measurement, the hyperinflation detection rate increased to 80.7%

Conclusion: Quantative lung radiodensity measurement of CXR in patients with suspected FB aspiration could increase the efficiency of FB related hyperinflation detection.