Foreign body aspiration

Question 1

epidemiologia

Answer 1

80% of cases occur in children < 3 years

Question 2

fisiopatologia

Answer 2

Aspiration of a FB → airway obstruction
Complete obstruction → collapse of the respiratory structures distal to the obstruction (e.g., atelectasis) .
Partial obstruction: formation of a ball-valve obstruction with air trapping → build-up of pressure distal to the obstruction

Question 3

Localizzazione

Answer 3

• Upper airway obstruction: a minority of FB are lodged in the larynx or trachea
• Bronchi: the right main bronchus is more often affected than the left main bronchus
• Aspirated particles are most likely to become lodged at the junction of the right inferior and right middle bronchi → right lower and middle lobe aspiration pneumonia

Question 4

Clinica

Answer 4

Immediate symptoms

• Choking and coughing
• Dyspnea
• Hoarseness and inability to speak
• Respiratory distress, cyanosis, altered mental state

Physical exam
-Diminished breath sounds on the affected side
-Stridor, wheezing
On inspiration: indicates laryngotracheal localization
On expiration: indicates bronchial localization
-Hyper-resonance on the affected side in partial obstruction

Late symptoms: days or weeks later if the initial aspiration and choking episode is not witnessed

• Persistent or recurrent cough
• Fever

Question 5

Diagnosi

Answer 5

1.Life-threatening FBA (respiratory distress) :immediate intervention (no imaging required!)

2. Stable patients with suspected FBA
   - Physical exam
   - Chest x-ray or CT (if x-ray is inconclusive)
   - Bronchoscopy

-Chest x-ray
.Focal hyperlucency and reduced pulmonary markings of the affected lung
.Atelectasis
.60% of FB are located in the right main bronchus due to the more vertical orientation compared to the left main bronchus

• CT (nearly 100% sensitivity): if x-ray is inconclusive
• Bronchoscopy: if imaging is inconclusive but there is a high clinical suspicion of FBA

If there is a high suspicion of FB aspiration, bronchoscopy or CT should be performed even if the chest x-ray is inconclusive!

Question 6

Managment

Answer 6

1. Life-threatening FBA
   - In alert patients, encourage coughing to dislodge FB
   - Heimlich maneuver: if the patient is unable to speak or cry
   - Intubation: Attempt to mobilize FB via endotracheal tube
   - Emergency tracheotomy may be required
2. Removing the foreign body
   - Bronchoscopy (gold standard)
   - In rare cases, surgical removal may be necessary

Question 7

Complicanze

Answer 7

• Atelectasis
• Postobstructive pneumonia, lung abscess

In complete obstruction:

• Suffocation, asystole, and death
• Hypoxia: brain damage