Foreign Body Aspiration Clinical Presentation

Updated: Dec 31, 2015
  • Author: Martin E Warshawsky, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

In the café coronary syndrome, a large object (often poorly chewed meat) lodges in the larynx or trachea, causing nearly complete airway obstruction. Respiratory distress, aphonia, cyanosis, loss of consciousness, and death occur in quick succession unless the object is dislodged. When the degree of obstruction is less severe or when the aspirated object descends beyond the carina, the presentation is less dramatic. Sudden onset of the classic triad (ie, coughing, wheezing, decreased breathing sounds) is frequently not observed.

Presenting symptoms (other than cough) include fever, hemoptysis, dyspnea, and chest pain. A history of a choking episode is not always obtained or may have initially been ignored or misdiagnosed. Most patients or parents can identify a specific episode of choking; however, presentation is often delayed by more than a week. The latency period prior to the onset of symptoms may last months or years if the foreign body is inert bone or inorganic material.

Patients may have been empirically treated for other conditions, even when a choking episode was witnessed. Patients with chronic symptoms may have been erroneously diagnosed as having asthma or chronic bronchitis. Young children and patients with neurologic or psychiatric disorders are at increased risk for aspiration but might not be able to describe symptoms or to report choking episodes.

Other risk factors include institutionalization, old age, poor dentition, and alcohol or sedative use. A presentation of cyanosis, cough, wheeze, incompletely resolved pneumonia, or localized bronchiectasis should raise suspicion of foreign body aspiration, particularly in individuals at risk for foreign body aspiration. Seek information about a history of impaired swallowing, impaired coughing, traumatic loss of consciousness, intoxication, or oropharyngeal surgery.

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Physical

A small number of foreign body aspirations are incidentally found after chest radiography or bronchoscopic inspection. Patients may be asymptomatic or may be undergoing testing for other diagnoses. If present, physical findings may include stridor, fixed wheeze, localized wheeze, or diminished breath sounds. If obstruction is severe, cyanosis may occur. Signs of consolidation can accompany postobstructive pneumonia.

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Causes

Children are at risk for putting small toys, candies, or nuts into their mouths. Children aged 1-3 years chew incompletely with incisors before their molars erupt, and objects or fragments may be propelled posteriorly, triggering a reflex inhalation.

Among adults, the following conditions, actions, and procedures facilitate foreign body aspiration:

  • Impaired swallow reflex
  • Impaired cough reflex
  • Mental retardation
  • Alcohol or sedative use
  • Poor dentition
  • Dental, pharyngeal, or airway procedures
  • Altered sensorium
  • Loss of consciousness
  • Convulsions
  • Maxillofacial trauma

Frequently aspirated objects include food (especially nuts and seeds), teeth, dental appliances, and medical instruments. The original event might have been forgotten. Choking with severe dyspnea, leading to respiratory or cardiac arrest while eating, might be initially misdiagnosed as myocardial ischemia.

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