Foreign Bodies of the Airway Workup

  • Author: Alan D Murray; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Aug 19, 2011
 

Imaging Studies

  • High-kilovolt anteroposterior and lateral radiographs of the airway are the tests of choice in patients in whom laryngeal foreign bodies are suspected. The high kilovoltage used produces greater definition of the airway while reducing the effect of the surrounding bony structures.
  • Posteroanterior and lateral chest radiographs are an adjunct to the history and physical examination in patients in whom foreign body aspirations are suspected. To at least have a baseline study for future comparison, perform chest radiographs on all such patients.
    • Radiopaque objects are visible, but radiolucent objects (eg, plastic) are not.[1]
    • Chest radiographs may reveal obstructive emphysema or hyperinflation, atelectasis, and consolidation.
  • Lateral decubitus chest films may be helpful in children in whom the dependent lung remains inflated with bronchial obstruction. Typically, the dependent lung collapses.
  • Chest radiographs (inspiratory and expiratory films) demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.
  • Biplane fluoroscopy uses intraoperative fluoroscopic evaluation while identifying and locating a foreign body within the lung periphery.
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Diagnostic Procedures

Chest auscultation is critical in the evaluation of a patient in whom a foreign body aspiration is suspected. Typically, these patients have wheezing, decreased breath sounds, or both on the side of the foreign body. Patients may have normal examination findings despite having a foreign body within the airway because it may partially obstruct the airway.

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Contributor Information and Disclosures
Author

Alan D Murray  MD, Pediatric Otolaryngologist, ENT for Children; Full-Time Staff, Medical City Dallas Children's Hospital; Consulting Staff, Department of Otolaryngology, Medical Center of Lewisville, Children's Medical Center at Dallas, Cook Children's Medical Center; Full-Time Staff, Texas Pediatric Surgery Center, Cook Children's Pediatric Surgery Center Plano

Alan D Murray is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Surgeons, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Kelley, MD  Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center

Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Bloom DC, Christenson TE, Manning SC, et al. Plastic laryngeal foreign bodies in chidren: A diagnostic challenge. Int J Pediatr Otorhinolaryngol. 2005;69:657-662.

  2. Holinger LD. Management of sharp and penetrating foreign bodies of the upper aerodigestive tract. Ann Otol Rhinol Laryngol. Sep 1990;99(9 Pt 1):684-8. [Medline].

  3. Kadmon G, Stern Y, Bron-Harlev E, Nahum E, Battat E, Schonfeld T. Computerized scoring system for the diagnosis of foreign body aspiration in children. Ann Otol Rhinol Laryngol. Nov 2008;117(11):839-43. [Medline].

  4. Black RE, Johnson DG, Matlak ME. Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg. May 1994;29(5):682-4. [Medline].

  5. Chatterji S, Chatterji P. The management of foreign bodies in air passages. Anaesthesia. Oct 1972;27(4):390-5. [Medline].

  6. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected foreign body inhalation in children: what are the indications for bronchoscopy?. J Pediatr. Aug 2009;155(2):276-80. [Medline].

  7. Deutsch ES, Dixit D, Curry J, et al. Management of aerodigestive tract foreign bodies: innovative teaching concepts. Ann Otol Rhinol Laryngol. May 2007;116(5):319-23. [Medline].

  8. Esclamado RM, Richardson MA. Laryngotracheal foreign bodies in children. A comparison with bronchial foreign bodies. Am J Dis Child. Mar 1987;141(3):259-62. [Medline].

  9. Holinger PH. Foreign bodies of the air and food passages. Trans Am Acad Ophthalmol Otolaryngol. 1966.

  10. Inglis AF Jr, Wagner DV. Lower complication rates associated with bronchial foreign bodies over the last 20 years. Ann Otol Rhinol Laryngol. Jan 1992;101(1):61-6. [Medline].

  11. McGuirt WF, Holmes KD, Feehs R, Browne JD. Tracheobronchial foreign bodies. Laryngoscope. Jun 1988;98(6 Pt 1):615-8. [Medline].

  12. Mu L, He P, Sun D. Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope. Jun 1991;101(6 Pt 1):657-60. [Medline].

  13. Murray AD, Mahoney EM, Holinger LD. Foreign bodies of the airway and esophagus. In: Cummings, et al. (eds). Otolaryngology-Head and Neck Surgery. Vol 5. (ed 3). St. Louis, MO: 1998:p 377.

  14. Murray AD, Walner DL. Methods in instrumentation for removal of airway foreign bodies. Operative Techniques in Otolaryngology-Head and Neck Surgery. March 2002;0(1):2-5.

  15. Ritter F. Questionable methods of foreign body treatment. Ann Otol Rhinol Laryngol. 1974;83:729.

  16. Shah RK, Patel A, Lander L, Choi SS. Management of foreign bodies obstructing the airway in children. Arch Otolaryngol Head Neck Surg. Apr 2010;136(4):373-9. [Medline].

  17. Svedstrom E, Puhakka H, Kero P. How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?. Pediatr Radiol. 1989;19(8):520-2. [Medline].

  18. Swanson KL, Prakash UB, Midthun DE, et al. Flexible bronchoscopic management of airway foreign bodies in children. Chest. May 2002;121(5):1695-700. [Medline].

 
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Aspirated foreign body (backing to an earring) lodged in the right main stem bronchus.
 
 
 
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