- A frantic mother brings her 2-year-old child to the emergency department after he swallowed an earring. Radiographs are shown.
- Aspirated solid or semi-solid object, usually lodged in the larynx or trachea
- most often food, but can range from small toys to coins to pens, and so on
- May be life-threatening is large enough to completely obstruct the airway
- Can lead to chronic, recurrent infection if retrieval is delayed
- usually presents after 6 months of age
- Risk factors include
- advanced age
- poor dentition
- sedative use
- severe obstruction may present with
- respiratory distress
- loss of consciousness
- and death in quick succession
- partial, long-term obstruction may present with
- less severe respiratory symptoms
- chest pain
- symptoms indicative of secondary infection
- Physical exam
- unresolved pneumonia
- decreased breath sounds
- shows hyperinflation of the affected side
- necessary for appropriately evaluating ventilation
- may be useful for following progression of respiratory failure when it is of concern
- Chronic URI, pneumonia, tonsillitis, pneumonia, pneumothorax, emphysema, respiratory failure
- Medical intervention
- endoscopic (flexible or rigid) retrieval of foreign body
- flexible broncoscopy is both diagnostic and therapeutic
- rigid broncoscopy is preferred in children due to wider instrument lumen (as compared to flexible counterpart), which allows for ventilation and easier removal of objects
- surgical removal
- indicated when endoscopy is impossible or unsuccessful
- If the object is thought to be in the esophagus, based on imaging and clinical presentation:
- Observe for 24 hours with serial radiographs and remove endoscopically if the object does not pass distally within that time frame
- If object causes symptoms or time-point of ingestion is unknown - attempt immediate endoscopic removal
- If the ingested item appears relatively benign and has already progressed inferior to the diaphragm on imaging, observe and wait for spontaneous passage
|Prognosis, Prevention, and Complications
- very good to excellent if identified and resolved early
- limit exposure to objects approved for specific age group (i.e. toys, etc)
- may lead to chronic pneumonia
- can cause sudden respiratory failure and death
AVERAGE 5.0 of 1 RATINGS
Qbank (0 Questions)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Maguire A, Gopalakaje S, Eastham K. All that wheezes is not asthma: a 6-year-old with foreign body aspiration and no suggestive history. BMJ Case Rep. 2012 Dec 12;2012.
PMID:23234818 (Link to Abstract)
Oncel M, Sunam GS, Ceran S. Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children. Pediatr Int. 2012 Aug;54(4):532-5.
PMID:22414345 (Link to Abstract)
Uyemura MC. Foreign body ingestion in children. Am Fam Physician. 2005 Jul 15;72(2):287-91.
PMID:16050452 (Link to Abstract)
Waltzman ML. Management of esophageal coins. Curr Opin Pediatr. 2006 Oct;18(5):571-4.
PMID:16969175 (Link to Abstract)
- First Aid for the USMLE STEP 2 CK. Le Tao. New York: McGraw-Hill Medical, 2012.
- Brochert's Crush Step 2. O'Connell, Theodore. Philadelphia: Elsevier Saunders, 2013.
- Master the Boards USMLE Step 2 CK. Fischer, Conrad. New York: Kaplan Publishing, 2012.
- Boards and Wards for USMLE Steps 2 and 3. Ayala, Carlos. New York: Lippincott Williams and Wilkins, 2012.