Foreign Body Aspiration

Toddlers – children who are mobile and can put small objects in their mouths (beads, peanuts)

History

  • Choking
  • Chest infection – not responding to treatment
  • Sudden onset unilateral wheeze
  • Persistent cough
  • Hemoptysis

Physical exam

  • Asymmetric chest signs:
    • Unilateral absence of breath sounds
    • Localized wheeze
  • Stridor
  • Bloody sputum

Red flags

  • Persistent wheeze unresponsive to ventolin
  • Persistent atelectasis
  • Recurrent or persistent pneumonia
  • Persistent cough with no explanation

Family History– siblings <5 years old will force feed baby

Imaging

  • CXR (ask for inspiration/expiration films)
    • Radio-opaque objects
    • Evidence of air-trapping on expiration (ball-valve mechanism)
    • Segmental collapse (complete collapse)
    • Lobar consolidation
    • Trachea shifts to unaffected side
    • FB usually enter right lung (right main stem bronchus – more continuous with trachea)
    • FB may also be in esophagus and compress trachea (look at lateral film)

Differential diagnosis

  • URTI
  • Pneumonia
  • Asthma
  • Acute bronchitis

Management

  • Heimlich manoeuvre if complete obstruction
  • Rigid bronchoscopy
  • Antibiotic if pneumonia
  • Prevention: educate parents, no nuts/carrots before child has molars, no toys with small parts, no walking with food

Leave a Comment