Foreign Bodies of the Airway Workup

Updated: May 07, 2019
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

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. [5] 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.

A recent study demonstrated an increase in false positives with lateral decubitus films and a questionable benefit with expiratory films when used in conjunction with plain chest radiography. [6]

Biplane fluoroscopy uses intraoperative fluoroscopic evaluation while identifying and locating a foreign body within the lung periphery.

A study by Behera et al indicated that virtual bronchoscopy using multidetector computed tomography (MDCT) scanning is effective in diagnosing the presence of radiolucent vegetable foreign bodies in the tracheobronchial airway. The study found that in 59 out of 60 pediatric cases, rigid bronchoscopy confirmed MDCT-scan findings with regard to the presence of a vegetable foreign body, as well as the foreign body’s size, shape, and location, giving virtual bronchoscopy a positive predictive value of 98.3%. [7]

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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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