• A frantic mother brings her 2-year-old child to the emergency department after he swallowed an earring. Radiographs are shown.foreign body aspiration
  • Aspirated solid or semi-solid object, usually lodged in the larynx or trachea
    • most often food, but can range from small toys to coins to pens, and so on
  • May be life-threatening is large enough to completely obstruct the airway
  • Can lead to chronic, recurrent infection if retrieval is delayed
  • Epidemilogy
    • usually presents after 6 months of age
  • Risk factors include
    • institutionalization
    • advanced age
    • poor dentition
    • alcohol
    • sedative use
  • Symptoms
    • severe obstruction may present with
      • respiratory distress
      • aphonia
      • cyanosis
      • loss of consciousness
      • and death in quick succession
    • partial, long-term obstruction may present with
      • less severe respiratory symptoms
      • dysphagia
      • fever
      • hemoptysis
      • dyspnea
      • chest pain
      • symptoms indicative of secondary infection
  • Physical exam
    • unresolved pneumonia
    • decreased breath sounds
    • wheezing
  • CXR
    • shows hyperinflation of the affected side
  • ABG
    • necessary for appropriately evaluating ventilation
    • may be useful for following progression of respiratory failure when it is of concern
  • Chronic URI, pneumonia, tonsillitis, pneumonia, pneumothorax, emphysema, respiratory failure
  • Medical intervention
    • endoscopic (flexible or rigid) retrieval of foreign body
      • flexible broncoscopy is both diagnostic and therapeutic 
      • rigid broncoscopy is preferred in children due to wider instrument lumen (as compared to flexible counterpart), which allows for ventilation and easier removal of objects
    • surgical removal
      • indicated when endoscopy is impossible or unsuccessful
  • If the object is thought to be in the esophagus, based on imaging and clinical presentation:
    • Observe for 24 hours with serial radiographs and remove endoscopically if the object does not pass distally within that time frame
    • If object causes symptoms or time-point of ingestion is unknown - attempt immediate endoscopic removal
    • If the ingested item appears relatively benign and has already progressed inferior to the diaphragm on imaging, observe and wait for spontaneous passage 
Prognosis, Prevention, and Complications
  • Prognosis
    • very good to excellent if identified and resolved early
  • Prevention
    • limit exposure to objects approved for specific age group (i.e. toys, etc)
  • Complications
    • may lead to chronic pneumonia
    • can cause sudden respiratory failure and death

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