Which statement about imaging is accurate?

• A. CT is always necessary after a negative X-ray
• B. Chest radiography alone can definitively exclude a foreign body
• C. Bronchoscopy is only used as a last resort after imaging fails
• D. If suspicion remains high with negative radiographs, bronchoscopy is indicated

Answer: (D)

In suspected foreign body aspiration, imaging has limitations. A chest X-ray can be normal even when a foreign object is present, especially if the object is radiolucent or not causing immediate radiographic signs. Because of this, a negative X-ray does not rule out a foreign body.

If clinical suspicion remains high despite negative radiographs, bronchoscopy is indicated. It serves both diagnostic and therapeutic roles: it provides direct visualization of the airway to locate the object and, if found, allows immediate removal during the same procedure. This approach helps prevent ongoing obstruction and potential complications such as recurrent pneumonia or chronic cough.

Radiographs can show indirect signs like unilateral decreased breath sounds or localized wheeze, but the absence of these signs does not guarantee absence of a foreign body, so relying solely on imaging is insufficient. CT scans are not required in every case and add radiation exposure; they’re not the standard next step when suspicion is high enough to warrant bronchoscopy. Bronchoscopy isn’t merely a last resort after imaging fails; it’s the appropriate next step when suspicion remains high after negative radiographs.