31 Foreign Body Aspiration

CASE 31


Clinical Presentation


An afebrile 18-month-old presents with acute onset of a cough, respiratory distress, and wheezing.


image

Figure 31A


Radiologic Findings


Conventional chest radiograph performed in appropriate inspiration demonstrated subtle asymmetric lucency, most obvious at the right base (Fig. 31A1). Mild hyperinflation of the right upper lobe also is seen with a slight shift of the mediastinal structures into the left hemithorax. Expiratory frontal view (Fig. 31A2) demonstrates overt mediastinal shift to the left secondary to extensive right-sided air trapping, the result of an aspirated piece of hamburger.


Diagnosis


Foreign body aspiration; aspiration of a piece of hamburger


Differential Diagnosis



  • Mucous plugging
  • Focal bronchostenosis or bronchomalacia
  • Extrinsic bronchial compression (aberrant vessel, congenital cyst, adenopathy)
  • Endobronchial lesion (rare in childhood)

Discussion


Background


Although foreign body aspiration can occur at any age, the peak age range is between 9 months and 4 years of age, when children are most likely to explore their surroundings with their mouth.


Clinical Findings


The radiographic diagnosis of foreign body aspiration requires a high index of suspicion that must be maintained when imaging children’s lungs. It is noteworthy that studies have shown that up to 20% of cases present with no choking episode (Hoeve et al), and up to 30% of cases may present to medical care more than a week after the episode of aspiration (Kim et al). Both the clinician and the radiologist must, therefore, have a low threshold for considering the utility of expiratory films to demonstrate focal air trapping.


Imaging Findings


RADIOGRAPHY

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Dec 21, 2015 | Posted by in PEDIATRIC IMAGING | Comments Off on 31 Foreign Body Aspiration

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