Interpretation of Chest X-ray in Foreign Body Aspiration and Lower Respiratory Tract Infections

Introduction

Foreign body aspiration and lower respiratory tract infections present significant diagnostic challenges in pediatric radiology. Chest X-ray interpretation plays a critical role in differentiating these conditions, guiding appropriate management.

Chest X-ray Findings in Foreign Body Aspiration

Direct Signs

• Visible foreign body (radiopaque) in the airway
• Obstruction-induced air trapping

Indirect Signs

• Unilateral hyperinflation due to ball-valve effect
• Mediastinal shift away from the affected lung
• Atelectasis in complete obstruction cases

Differential Diagnosis

Distinguishing foreign body aspiration from lower respiratory tract infections requires careful evaluation.

Bronchopneumonia vs. Foreign Body Aspiration

• Bronchopneumonia: Patchy opacities, peribronchial cuffing, air bronchograms
• Foreign Body Aspiration: Focal hyperinflation, asymmetric lung involvement, possible atelectasis

Imaging Techniques for Further Evaluation

When clinical suspicion is high but the X-ray is inconclusive, further imaging may be needed:

• CT scan for detailed airway visualization
• Bronchoscopy for direct foreign body retrieval

Conclusion

Chest X-ray interpretation is crucial in evaluating foreign body aspiration and distinguishing it from lower respiratory tract infections. Awareness of key radiological signs helps clinicians make accurate diagnoses and provide timely intervention.