Inhaled Foreign Body

Question 1

Foreign body inhalation mainly affects who?

Answer 1

Children between 1-3y

Question 2

What are the classical signs and symptoms of inhaled foreign body?

Answer 2

Coughing or choking, wheezing and unilateral reduced breath sounds

Exam = increased RR, decreased O2 sats, pyrexia if infection, tracheal shift, decreased breath sounds, wheeze, bronchial breath sounds

Question 3

In what location are inhaled foreign bodies most often found?

Answer 3

Right bronchial tree (60%)

Left bronchial tree (23%)

Trachea (13%)

Larynx (3%)

Question 4

What are the possible complications of an inhaled foreign body

Answer 4

Pneumonia

Pneumothorax

Lung abscess

Death

Persistent cough and bronchiectasis

Question 5

How does an inhaled foreign body present on CXR?

Answer 5

• Radio-opaque foreign body
• Air trapping, expansion of ribs
• Mediastinal shift
• Atelectasis
• Pneumothorax or pneumonia

CXR is normal in about a third of cases

Definitive diagnosis is only with direct bronchoscopy

Question 6

Outline a DDx for inhaled foreign body

Answer 6

• Asthma
• Pneumonia
• TB
• Epiglottitis
• Retropharyngeal abscess
• Peritonsillar abscess
• Post-viral pericarditis or pleuritis
• Bronchiolitis

Question 7

How should a suspected inhaled foreign body be managed?

Answer 7

Assess severity

• Effective cough = encourage cough
• Ineffective cough = 1) unconscious (open airway, 5 breaths, start CPR), 2) conscious (5 back blows, 5 thrusts)

Referred immediately to a paediatric ENT

Rigid bronchoscopy

Foreign bodies are removed from the airway under direct vision with optical forceps, dormia baskets or bronchial lavage