Purpose or Case Report: Ingested foreign bodies (FB) are frequently encountered in the pediatric population, whether accidental or deliberate and may lodge in the airways or esophagus. Metallic FB (e.g., coins, button batteries, magnets) are radio-opaque and easily detected on radiographs, conversely non-metallic objects (e.g., plastic toys, food) are radiolucent and often require CT, leading to diagnostic delays. The purpose of this study is to assess sensitivity for chest radiography and chest CT for endoscopically proven airway and esophageal food and non-food FBs.
Methods & Materials: This retrospective observational study examined pediatric patients (aged 0-18 years) with ingested FB (both airway and GI tract up to the stomach) treated at a tertiary care hospital between October 2021 and September 2024. Data were extracted for patients undergoing FB removal through upper GI endoscopy (CPT 43247) or bronchoscopy (CPT 31635), and who had undergone chest radiographs (CXR) or CT within 24 hours prior. Patients were categorized into three groups: CXR only, CT only, or both CXR and CT, with findings recorded from both imaging and procedure reports including FB type- food vs non-food, location etc. Sensitivity was calculated for each modality overall and for food vs. non-food FB subgroups.
Results: Of the 225 endoscopy cases, 58 (25.8%) involved airway FB, while 164 (72.9%) involved esophageal FB. Sensitivity for detecting airway FB was 30% for CXR and 97.4% for CT. Sensitivity for esophageal FB was 79.2% for CXR and 95.8% for CT. Food-related FB comprised 52 (23.1%) of cases, while non-food FB comprised 141 (62.7%) cases. CXR sensitivity for identifying food FB was 3%, while for non-food FB it was 82.2%. CT demonstrated 97.6% and 95.3% sensitivity for food and non-food FB, respectively.
Conclusions: CT is more sensitive than CXR, especially for detecting airway and food-related FB. Low-dose CT should be prioritized for known non-metallic or food FB, while XR may be appropriate for known metallic FB or as an initial imaging for unknown suspected FB, with CT used if XR findings are inconclusive.