Use of an endoscopic urology basket to remove bronchial foreign body in the pediatric population

Foreign body (FB) aspiration is a common problem in the pediatric population. Rigid bronchoscopy is considered the treatment of choice for removal of tracheobronchial FB. This is a report of two cases of tracheobronchial foreign body aspiration that were managed using an endoscopic urology basket through a flexible bronchoscope. This report's main purpose is to inform physicians on the benefit of flexible bronchoscopy and of the potential use of the endoscopic urology basket for tracheobronchial FB retrieval. We hope that the flexible bronchoscopy and the endoscopic basket will become a standard tool in FB retrieval kits for pediatric otolaryngologists who deal with this issue on a routine basis.     

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

Objectives

Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB.

Methods

We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images.

Results

The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups.

Conclusion

The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.     

Pediatric obstructive fibrinous tracheal pseudomembrane--characteristics and management with flexible bronchoscopy

Objective

To evaluate the incidence, characteristics, flexible bronchoscopy (FB) findings, interventions and outcome of pediatric obstructive fibrinous tracheal pseudomembrane (OFTP) in our pediatric and neonatal intensive care units (ICUs).

Patients and methods

This is a retrospective study of medical and FB video records in a single tertiary university-affiliated teaching hospital over a ten-year period. Data was collected from patients who were admitted and extubated of endotracheal tube in the ICUs with a FB diagnosis of an OFTP-like lesion. The associated medical information, FB interventions and video records were reviewed and analyzed.

Results

Eight patients with OFTP were enrolled, with an incidence rate of 1.48% in the postextubation respiratory distress patients. Mean age was 32 ± 32 months (range, 2 months to 13 years); mean body weight was 13.7 ± 8.1 kg (range, 4.3-45 kg); mean intubation period was 37.6 ± 12.3 h; mean time for symptoms to develop after extubation was 3.6 ± 1.4 h. Symptoms lasted for 20.8 ± 20.3 h before FB examination. All patients were accurately diagnosed with OFTP at the first postextubation FB examination and revealed various morphologies. The estimated cross-sectional tracheal lumen was reduced by 70-90% and the mean length of lesion was 18.1 ± 5.2 mm (range, 10-30 mm). All OFTP were successfully ablated immediately after the diagnosis in one FB session by using various techniques and without any complication. Total duration for both diagnostic and interventional FB was 19.4 ± 2.5 min. No recurrence was noted thereafter.

Conclusions

OFTP should always be considered in the event of postextubation respiratory distress, especially in the pediatric and neonatal ICUs. Early diagnosis and effective ablation can be achieved with aid of FB.     

Food foreign body injuries

Rationale and aimThe purpose of this study is to acquire a better understanding of Food Foreign Bodies (FFB) injuries in children characterizing the risk of complications and prolonged hospitalization due to food items according to patients’ characteristics, circumstances of the accident, Foreign Body (FB) features and FB location, as emerging from the SUSY Safe Web-Registry.MethodsThe present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project started in February 2005, which was aimed at establishing an international registry of cases of Foreign Bodies (FB) injuries in children aged 0–14 years. The analysis was carried out on injuries due to a food item.FB location was reported according to ICD9-CM code: ears (ICD931), nose (ICD932), pharynx and larynx (ICD933) trachea, bronchi and lungs (ICD934), mouth, esophagus and stomach (ICD935).Age and gender injury distributions were assessed. Data regarding adult supervision and activity before injury were also evaluated. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and hospitalization/complications was computed using unweighted odds ratios and the related 95% confidence intervals.Results16,878 FB injuries occurred in children aged 0–14 years have been recorded in the SUSY Safe databases. FB type was specified in 10,564 cases; among them 2744 (26%) were due to a food item. FB site was recorded in 1344 cases: FB was located in the ears in 99 patients, while 1140 occurred in the upper and lower respiratory tract; finally, 105 food items were removed from mouth, esophagus and stomach. Complications occurred in 176 cases and the most documented was pulmonary or bronchial infections (23%) followed emphysema or atelectasis and by and asthma (7%). Bones were the commonest retrieved FFB encountered in this study, while nuts seem to be the FFB most frequently associated to complications.ConclusionsOn the basis of this study we make the strong recommendation that parents should be adequately educated and provide age-appropriate food to their children and be present in order to supervise them during eating especially during a critical period ranging from 2 to 3 years of age.     

Foreign body aspiration, a continuously growing challenge: Tanta University experience in Egypt

Objective

To evaluate the different factors that affect the spectrum and frequency of foreign body (FB) aspiration as a growing problem in different ages, and express the experience of our department in managing the problem in the recent two decades.

Methods

The charts of 3600 patients who underwent bronchoscopic evaluation over a period of 20 years for a suspicion of FB inhalation were reviewed. The patients were divided according to the age into group A; up to 10 years, and group B; more than 10 years. Each group was investigated and compared with the other with respect to sex, history of FB aspiration, time elapsed between aspiration and hospital admission, clinical and radiographic findings, and FB location, type, retrieval, and complications. Seasonal, geographic, and socio-cultural factors and frequency of FB aspiration in relation to the study period were also recorded.

Results

In group A, boys were affected more than girls (1.3:1), while in group B, females were affected more than males (40.5:1). Among history positive patients in group A (72.8%) and B (96.8%), FB was detected in 88% and 97% respectively, while among history negative patients, FB was found higher in group A (49%) than group B (25%). The time elapsed before admission was longer in group A than group B. Cough was the most prominent symptom, while decreased breath sounds was the commonest sign in both groups. Pneumatic infiltration was the most frequent radiographic finding in group A (33.6%), while radio-opaque FB was higher in group B (94.1%). Peanut (67.3%) and seeds (21.2%) were the commonest FBs detected in group A, whereas, headscarf pins (91.3%) were predominant in group B. Foreign bodies were almost equally distributed in the laryngotracheobronchial tree in group A, while the left bronchial tree was much more affected in group B. Rigid bronchoscopy was used in groups A and B with a success rate of 99.8% and 99.7% respectively, while flexible bronchoscopy was only used in 0.2% in group B. Complications such as laryngotracheal edema (16.6%) and pneumothorax (2.3%) were encountered in group A more than group B (3.1%, 1.2%) and there was no mortality. Most of the aspirated FBs were recorded during summer months and commonly detected in patients of low socio-cultural status in both groups.

Conclusion

Foreign body aspiration is a continuously growing problem in Lower Egypt affecting all ages with two peaks at 3 and 14 years old. The rate of FB aspiration was affected by age; sex; traditions and believes; and seasonal, geographic, and socio-cultural factors. A high index of suspicion, rapid hospital admission, and bronchoscopic evaluation by experienced specialists were crucial for successful retrieval of the FB with low rate of morbidity. Public awareness through mass media needs attention to decrease the growing rate of this problem.     

Glottic foreign body in a child with pre-existing vocal cord paralysis and reflux laryngitis: A challenging diagnostic paradigm

Purpose: To illustrate the challenge and approach to diagnosing a laryngeal foreign body (FB) in a child with pre-existing laryngeal pathology. Methods: Case report. The diagnosis of laryngeal FB was initially missed in a 21-month old-infant. Two weeks later, the child experienced worsening in symptoms. Results: Flexible laryngoscopy revealed the presence of a plastic object in the subglottis, which was then removed under general anesthesia. Conclusions: For children with pre-existing laryngeal pathology, a sudden unexplained worsening of laryngeal symptoms, particularly dysphonia and biphasic stridor, should prompt the clinician to consider the possibility of a thin, sharp laryngeal FB.     

Esophageal foreign bodies: a Jordanian experience

OBJECTIVES: To study the pattern of esophageal foreign bodies (FB) in Jordan and to compare it with other countries. METHODS: This is a retrospective study conducted on all patients (527) who were admitted with esophageal FB during a period of 9 years from January 1992 to January 2000. Two major referral hospitals were involved: the Princess Basma and Al-Bashir hospitals. A data sheet was constructed in which we included: name, age, gender, presenting symptoms, type and site of FB, technique of removal, and complications if present. RESULTS: Of the 527 patients 53% were male and 47% were female.77% were children under the age of 10 years. In children coins were by far the most common FB to be found in the esophagus (68%), while bones were the principal FB to be found in adults (8%). In 89%, the FB was found at the level of cricopharyngeal muscle. Drooling of saliva (72%), dysphagia (71%), and vomiting (24%) were the most commonly presenting symptoms. Both rigid esophagoscopy and Magill forceps techniques were used to remove the FB from the esophagus. The complication rate was 2% which included: esophageal perforation and mediastinitis, esophageal stenosis and esophageal erosions. CONCLUSION: The pattern of esophageal FB in Jordan is not different from other countries.     

ENT foreign bodies: profile of the cases seen at a tertiary hospital emergency care unit

Individuals often seek help with foreign bodies (FB) in their ears, noses, and throats. Proper recognition, study, and management of foreign bodies is required to prevent complications.ObjectiveTo analyze the profile of the patients seen for FB at a reference otorhinolaryngology emergency care unit between February of 2010 and January of 2011.MethodCross-sectional retrospective historical cohort study based on digitized patient charts.ResultsFB accounted for 827 cases and 5.3% of all patients seen in the ENT emergency unit. Children were affected more frequently, particularly when aged 8 and under. No statistically significant differences were seen between genders. Foreign bodies were mostly located in the ears (64.4%), followed by the nasal fossae (19.5%), and the oropharynx (8.9%). Complications were seen in 4.5% of the cases, and 4.4% required general anesthesia to have the FB removed.ConclusionIn our ENT practice, foreign bodies were more commonly seen in children; the ears were the preferential site of occurrence. Complication rates and use of general anesthesia were low in our practice. It should be stressed that ENT foreign bodies need to be properly managed so as to avoid complications.     

The relationship between stream segregation and frequency discrimination in normally hearing and hearing-impaired subjects

We examined the relationship between the fission boundary (FB) at which a sequence of pure tones alternating between two frequencies cannot be heard as two separate streams and the frequency difference limen (FDL), using normally hearing subjects and subjects with cochlear hearing loss. The stimuli used in the two tasks were as similar as possible in duration and inter-tone interval. The frequency range examined was 250-8000 Hz for the normally hearing subjects and 250-2000 Hz for the hearing-impaired subjects. For normally hearing subjects, the FBs were almost invariant with frequency when expressed as ERB(N) values; the mean FB was about 0.4 ERB(N). The FDLs, also expressed as ERB(N) values, increased for frequencies above 2000 Hz. The ratio FB/FDL was roughly constant at 7-9 in the frequency region 250-2000 Hz, but decreased for higher frequencies, reaching about 1 at 8000 Hz. For the hearing-impaired subjects, FB/FDL ratios varied over a large range (1-40), and were not systematically related to the amount of hearing loss. These results suggest that the FB is not determined solely by the discriminability of successive tones.     

豚鼠上橄榄外侧核γ－氨基丁酸阳性神经元向耳蜗和耳蜗核的分支投射

为探讨豚鼠上橄榄外侧核内γ－氨基丁酸（ＧＡＢＡ）阳性神经元是否同时支配同侧Ｃｏｒｔｉ器和耳蜗核，采用逆行追踪的方法，将Ｆａｓｔｂｌｕｅ（ＦＢ）和Ｄｉａｍｉｄｉｎｅ黄（ＤＹ）两种不同性质的荧光素分别注入耳蜗鼓阶及同侧耳蜗核，观察上橄榄外侧核内ＧＡＢＡ阳性神经元的分支投射。结果发现，同侧上橄榄外侧核内ＦＢ单标细胞占标记细胞的８０．８％；ＤＹ单标细胞占１２．４％；ＦＢ－ＤＹ双标细胞占６％；ＧＡＢＡ、ＦＢ、ＤＹ三标阳性细胞占０．７％。对侧上橄榄外侧核内ＦＢ、ＤＹ单标细胞均较少，未见双标细胞。结果表明，豚鼠上橄榄外侧核内有ＧＡＢＡ免疫反应阳性神经元向同侧的Ｃｏｒｔｉ器和耳蜗核并行投射，但数量较少，支配Ｃｏｒｔｉ器和耳蜗核的传出神经纤维，分别来自不同的听觉传出神经核团。     

A transnasal foreign body penetrating the spinal cord from the nasopharynx

Objective and importanceThis is the first article regarding a transnasal Foreign bodies (FB) penetrating the spinal cord. We tried to remove it safely with a bilateral approach by performing a nasal endoscopy and partial laminectomy.Clinical presentationDuring logging work, a tree hit the occipital region of a 47-year-old man, producing unconsciousness with left paresis. Although he did not remember his injuries due to traumatic amnesia, a computed tomography (CT) scan showed a metal rod lodged from the left side wall of the nasopharynx to the spinal column at the cranial–cervical transition.InterventionA C1 laminectomy, partial occipital bone resection, and endoscopic intranasal extirpation were done jointly by an otolaryngologist and neurosurgeon under general anesthesia to safely remove the FB. All procedures were performed in the right lateral decubitus position so we could approach both the nasopharynx and occipital sides. The otolaryngologist withdrew the FB from the nasal cavity using an endoscope while the neurosurgeon monitored the occipital bone side. The FB was safely removed.ConclusionThe site of penetration at the nasopharynx contracted gradually to a scar with no cerebrospinal fluid (CSF) leak. The patient was finally discharged 39 days after surgery with no motor/sensory paralysis.     

Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children

Metallic foreign body (FB) ingestion is a common occurrence in the general paediatric population. We have shown that the use of a commercially available metal detector is sensitive in localizing and confirming metallic FB objects in the digestive tract. METHOD: In a double-blinded randomized control trial, we used a commercially available metal detector to localize metal coins in the digestive tract in an animal model. Localization of the coins was confirmed using fluoroscopy. In 10 consecutive patients with metallic FB ingestion, detection and localization of the FB using the metal detector was compared with standard confirmatory radiographic imaging. RESULTS: Using a commercially available, hand-held metal detector, we were able to localize a metallic FB in the gastrointestinal tract with 100% sensitivity in both the animal model and in 10 paediatric patients.     

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Objectives

Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives.

Methods

We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy.

Results

Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB.

Conclusions

Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.     

Endodontic treatment: a significant risk factor for the development of maxillary fungal ball

Objectives

The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.

Methods

One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.

Results

There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).

Conclusion

Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.     

Foreign bodies in the upper airways causing complications and requiring hospitalization in children aged 0–14 years: results from the ESFBI study

Foreign body (FB) aspiration/inhalation is a serious problem because it is still a cause of death in children, especially among those younger than 4 years. The objective of this paper is to characterize the risk of complications and prolonged hospitalization due to foreign bodies (FB) in the upper airways in terms of the characteristics of the injured patients (age, gender), typology and features of the FBs, the circumstances of the accident and the hospitalization details. A retrospective study in the major hospitals of 19 European countries was realized on injuries occurred in the years 2000–2002 and identified by means of the International Classification of Diseases, Ninth Revision (ICD-9) codes listed on hospital discharge records. In 170 cases, it was reported an injury due to the presence of a FB in the pharynx and larynx (ICD933) and in 552 records, it was reported a FB located in the trachea, bronchi and lungs (ICD934). Unlike the complications that occurred in 70 (12.7%) of cases, the hospitalizations were present in 433 (77.6) of the total injuries. One patient died. A higher incidence in males (63%) was observed. Median age for children who experienced complications was 2 years. The most common FB removal technique was laryngoscopy and bronchoscopy. In majority of the cases, children were treated by ENT department. The most common FBs were nuts, seeds, berries, corn and beans. In general, small, round crunchy foods pose a risk of choking. Since prevention is the most essential key to deal with these types of injuries, more effort in caregivers’ public education is warranted.     

Flexible bronchoscopy as a valuable tool in the evaluation of infants with stridor

The aim is to determine clinical characteristics, flexible bronchoscopy (FB) findings including associated airway abnormalities and other conditions, treatment modalities and long term follow-up of children with congenital stridor. Medical records of children, who underwent FB for the evaluation of stridor between 1 January 2004 and 31 December 2009 were retrospectively reviewed. Demographic characteristics, symptoms and physical examination findings at presentation, FB findings, follow-up data including the time to resolution of symptoms and treatment modalities, presence of associated conditions were assessed. 109 children were enrolled to the study. Laryngomalacia was the most common etiology for stridor. Laryngomalacia was isolated in 37 patients and 54 patients had secondary airway lesions (SALs). Diagnoses other than laryngomalacia such as subglottic hemangioma, subglottic web, isolated tracheomalacia were found in 18 patients. In 90 % of patients, stridor resolved before 3 years of age without any surgical intervention and there was no significant difference in terms of the persistence of stridor between patients with isolated laryngomalacia and associated SALs. Duration of stridor was significantly longer in both patients with neurological abnormalities and reflux symptoms. Surgical procedure was performed in 19 of the patients. There is a high incidence of SALs in patients with laryngomalacia. FB is helpful for identifying anomalies requiring surgical treatment.     

Foreign bodies in the nose causing complications and requiring hospitalization in children 0-14 age: results from the European survey of foreign bodies injuries study

INTRODUCTION: The occurrence of foreign bodies (FB) in otorhinolaryngological practice is a common and serious problem among pediatric patients. The aim of this work is to characterize the risk of complications and prolonged hospitalization due to FBs in the nose in terms of the characteristics of the injured patients (age, gender), typology and features of the FBs, the circumstances of the accident and the hospitalization's details. MATERIALS AND METHODS: A retrospective study of FB associated injuries, assessing the characteristics of the injured child and the FB, the circumstances of the accident and finally the hospitalization details took place on children aged 0-14 in major hospitals of 19 European countries. RESULTS: In total 688 cases were assessed. Complications and hospitalization occurred in 59 and 52 cases, respectively. Over 51% of patients were females. The median age of children who experienced a complication was four years. In the majority of cases FB removal was accomplished by means of a non-invasive technique (rhinoscopy with a nasal speculum or rigid fiberoptic endoscope. The majority of children were directly referred to the ENT department. The most common FBs associated with complications and hospitalization were nuts, seeds, berries, corn and beans, batteries and other inorganic objects such as broken parts of pens, paper clips and pearls. Over 38% of the injuries occurred under adults' supervision. DISCUSSION: FB injuries in the nose are commonly encountered in clinical practice. Even if the presence of a FB is not usually life threatening, it may result in long-term complications such as perforation of the septum. Because the risks associated with FB injuries, public education about this problem is recommended.     

Extraction of dental crowns from the airway: a multidisciplinary approach

We describe two cases of airway foreign bodies (FB) consisting of a dental crown. The shape and composition of dental crowns complicate their extraction from the tracheobronchial tree, sometimes necessitating thoracotomy. We describe the use of a multidisciplinary approach involving rigid and flexible bronchoscopy in concert with the use of wire snares under fluoroscopic guidance for extraction of these challenging FB. These cases illustrate that this multidisciplinary approach can allow successful extraction of the difficult FB from much of the tracheobronchial tree and the avoidance of thoracotomy.     

98例真菌球型鼻窦炎的临床特点和鼻声反射分析

目的:提高对真菌球型鼻窦炎的正确诊断和治疗。方法:对98例真菌球型鼻窦炎患者的首发症状、鼻声反射结果、CT表现、手术方式进行回顾性分析。结果:鼻窦真菌球型鼻窦炎患者首发症状包括涕中带血、鼻塞、头面部疼痛、鼻腔异味、溢泪及无症状。术前鼻镜检查43.9%无明显异常,13.3%鼻中隔明显偏曲,41.8%鼻腔有新生物,25.5%鼻腔有分泌物。鼻窦真菌球型鼻窦炎患者鼻气道通气阻力、鼻腔总容积、鼻腔最小截面积与同性别正常人比较均差异有统计学意义(均P<0.01)。CT表现多为单侧鼻窦受累,不均匀或均匀不透光改变。术前CT诊断为真菌球型鼻窦炎与术后病理诊断的符合率为65.3%,真菌球以上颌窦发病率最高(54.1%),次为蝶窦(11.2%)、筛窦(5.1%)、额窦(2.0%),多窦受累及占32.7%。所有患者行功能性鼻内镜手术,结合不同角度内镜彻底清理病变。结论:真菌球型鼻窦炎临床症状不典型,鼻声反射检测提示鼻气道通气阻力增加,鼻腔总容积、鼻腔最小截面积缩小,可能成为影响鼻腔通气导致条件致病真菌感染的原因;术前CT检查对真菌病的诊断大有帮助,功能性鼻内镜手术是治疗真菌球型鼻窦炎的有效手段。     

3D images based on MDCT in evaluation of patients with suspected foreign body aspiration

To evaluate the value of 3D images based on multi-detect computer tomography (MDCT) for the diagnosis and management of patients with suspected foreign bodies aspiration, and report our experience about diagnosis and management of the aforementioned patients using the 3D images, as well as detail our protocol for the management of those patients. Forty-four patients (37 children, 7 adults) with suspected foreign bodies aspiration who accepted pre-surgical examination and bronchoscopy in our hospital were included in this study. All the patients’ pre-surgical 3D images based on MDCT were reconstructed and analyzed. After that all the results were compared with observations in the surgeries. Among the 37 pediatrics, 34 patients were detected with FB in their tracheobronchial system by the 3D images based on MDCT, and 3 cases were detected negative. The sensitivity of 3D images is 100 %, and the specificity is 75 %.In the adult group, all the 7 cases of FB in the tracheobronchial tree were detected by 3D images and proved by bronchoscopy. 3D images based on MDCT were proved to be a valuable method for the diagnosis of the patients with suspected FB aspiration. In the diagnosis and management of those patients, we considered that both the typical FB aspiration history and the intractable symptoms of cough should be taken as the criteria and the first step for selecting those suspected patients; then 3D images based on MDCT could be taken as the second step and as the selective criteria for those patients who should accept the rigid bronchoscopy.