Foreign Body Aspiration

Background

• Foreign body aspiration is the unintentional inhalation of a foreign body (objects or food) into the airway, usually resulting in partial or complete respiratory obstruction.
• Aspiration occurs most often in children < 3 years old, and is more common in boys. Among adults, aspiration more common after age 50 years.

Evaluation

• Common clinical presentation includes:
  • acute choking episode with coughing, wheezing, or stridor
  • patient or caregiver reports history of playing with a small object or eating
• Diagnosis may be confirmed by imaging or after successful removal of foreign body by the Heimlich maneuver or by endoscopy.
  • Obtain anteroposterior and lateral chest x-rays if foreign body aspiration is suspected. Most foreign bodies are radiolucent, so look for indirect signs such as atelectasis or air trapping. (X-ray may be normal within 24 hours of aspiration episode.)
  • Computed tomography (CT) and magnetic resonance imaging (MRI) are rarely used.
  • Bronchoscopy may be used for both diagnosis and treatment of foreign body aspiration.

Management

• Perform Heimlich maneuver in emergency cases, such as complete airway obstruction or suspected battery aspiration, followed by emergency endoscopy in cases of persistent obstruction.
• No emergency measures are indicated for children who can speak, cry, or cough following an aspiration episode.
• Closely monitor patients with suspected aspiration of beans and seeds as this type of foreign body may expand and block airway.
• Endoscopic removal by bronchoscopy is indicated in most patients presenting with foreign body aspiration.
• Emergency tracheotomy or thoracotomy may be indicated in cases of failed bronchoscopic removal.