Snapshot A frantic mother brings her 2-year-old child to the emergency department after he swallowed an earring. Radiographs are shown. 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 IMAGING 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