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Updated: Dec 25 2021

Foreign Body Aspiration

Images of foreign body.jpg
  • Snapshot
    • A frantic mother brings her 2-year-old child to the emergency department after he swallowed an earring. Radiographs are shown.foreign body aspiration
  • Introduction
    • 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
  • Epidemiology
    • Usually presents after 6 months of age
    • Risk factors include
      • institutionalization
      • advanced age
      • poor dentition
      • alcohol
      • sedative use
  • Presentation
    • 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
    • Foreign body
      • CXR
        • shows hyperinflation of the affected side
    • Acid/alkali ingestion
      • after initial stabilization:
        • chest radiograph
        • gastrografin swallow
        • endoscopy
  • studies
    • ABG
      • necessary for appropriately evaluating ventilation
      • may be useful for following progression of respiratory failure when it is of concern
  • Differential
    • Chronic URI, pneumonia, tonsillitis, pneumonia, pneumothorax, emphysema, respiratory failure
  • Treatment
    • Prevention
      • limit exposure to objects approved for specific age group (i.e. toys, etc)
    • 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
  • Complications
    • May lead to chronic pneumonia
    • Can cause sudden respiratory failure and death
  • Prognosis
    • Very good to excellent if identified and resolved early
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