Airway foreign bodies in children

Changed by Henry Knipe, 15 Sep 2014

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Airway foreign bodies in children are potentially fatal and proper recognition is important because delayed diagnosis is common.

Epidemiology

Children under the age of four years are at increased risk of foreign body (FB) aspiration with a slight male predominance ¹.

Clinical presentation

Most children (~70%) are witnessed to have a choking event at the time of aspiration. Children may otherwise present with cough, dyspnoea or irritability ^2,6.

Pathology

Most (70-90%) foreign bodies are organic, most commonly seeds and nuts. Inorganic foreign bodies vary dramatically and can include teeth, coins, pins, pens/crayons, etc.

Aspirated foreign bodies have a predominance for the right tracheobronchial tree ⁶.

Radiographic features

Plain film

chest x-ray will be normal in ~35% (range 30-40%) of patients ^1-2
unilateral emphysema or atelectasis are the most common findings; only uncommonly will a radio-opaque foreign body be demonstrated ^1-2

CT

can be useful in assessment of missed or retained foreign body after initial bronchoscopy ³

Treatment and prognosis

Bronchoscopy is considered the gold-standard in the diagnosis of tracheobronchial tree foreign bodies ³ with the added benefit of being able to potentially retrieve the foreign body.

Complications

Differential diagnosis

oesophageal foreign body
- flat FBs (e.g. coins) tend to lie a coronal plane in the oesophagus ⁴

~~-<li><a title="bronchospasm" href="/articles/bronchospasm">bronchospasm</a></li>~~
+<li><a href="/articles/bronchospasm">bronchospasm</a></li>
~~-<li><a title="broncho-oesophageal fistula" href="/articles/broncho-oesophageal-fistula">broncho-oesophageal fistula</a></li>~~
+<li><a href="/articles/broncho-oesophageal-fistula">broncho-oesophageal fistula</a></li>
~~-</li></ul><h4>See also</h4><ul><li><a href="/articles/foreign_bodies">foreign bodies</a></li></ul>~~
+</li></ul><h4>See also</h4><ul>
+<li><a href="/articles/foreign-bodies">foreign bodies</a></li>
+<li><a title="Ingested foreign bodies in children" href="/articles/ingested-foreign-bodies-in-children-1">ingested foreign bodies in children</a></li>
+</ul>

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