Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Bronchial Foreign Body
KEY FACTS
Terminology
-
Complete or partial bronchial occlusion by aspirated foreign body (FB)
Imaging
-
Vast majority of aspirated FBs are not radiopaque
-
Look for unilateral static lung volume on chest radiographs
-
In uncooperative patients (most common), obtain frontal view + bilateral decubitus images: Look for lack of passive deflation of dependent lung, suggesting air-trapping
-
In cooperative patients, frontal radiographs can be obtained at maximum inspiration & expiration: Look for static appearance on affected side
-
-
Volume of affected lung segments can be normal, ↑, or ↓
-
Consider CT with multiplanar reconstructions & 3D virtual bronchoscopy in cases with persistent clinical suspicion & negative chest radiographs
Top Differential Diagnoses
-
Refractory asthma, viral lower respiratory tract infection, pulmonary sling
Clinical Issues
-
Age: Most common at 1-3 years; peak at 18 months
-
Aspiration often unwitnessed or not remembered until later: High degree of suspicion important
-
Delay in diagnosis associated with ↑ complication rate: Bronchopulmonary fistula, bronchial rupture, damage to distal lung, granuloma formation
-
-
Presentation may be acute or delayed
-
Same day (25%): Wheezing, cough, ± fever
-
Days 2-7 (45%) or delayed by > 1 week (30%): Indolent cough, medically refractory wheezing, dyspnea
-
Complete obstruction: Atelectasis & collapse
-
Partial obstruction leads to “ball-valve” effect: Air-trapping & hyperinflation
-
-
Treatment: Bronchoscopic removal of FB
Portable chest radiograph of a 3-year-old patient who aspirated glass fragments during a car crash shows 3 small radiopaque foreign bodies in the right lower lobe bronchus
. There is resulting airspace opacity
as well as volume loss causing elevation of the right hemidiaphragm & slight mediastinal shift.
. There is resulting airspace opacity as well as volume loss causing elevation of the right hemidiaphragm & slight mediastinal shift.
Axial CECT in the same child shows a square-shaped radiopaque glass foreign body
in a segmental bronchus of the right lower lobe.
in a segmental bronchus of the right lower lobe.
Bronchoscopic image from the same patient shows complete occlusion of the segmental bronchus by glass fragments
.
.
Frontal radiograph of a toddler found unconscious in a debris pile after a flood shows a small, well-defined opacity in the left main bronchus
. The left lower lobe is relatively hyperlucent due to air-trapping
, & there are widespread patchy opacities due to aspiration
. The bronchial obstruction was due to a small aspirated stone. (Gastric contrast was related to the tube placement.)
. The left lower lobe is relatively hyperlucent due to air-trapping , & there are widespread patchy opacities due to aspiration . The bronchial obstruction was due to a small aspirated stone. (Gastric contrast was related to the tube placement.)
TERMINOLOGY
Abbreviations
-
Foreign body (FB), foreign body aspiration (FBA)
Definitions
-
Complete or partial bronchial occlusion by aspirated FB
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
