Volume 1, Case
8
Foreign Body Aspiration in a Child
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 8
Rodney B. Boychuk, MD
A 17 month old male presents to
the ED in the evening with a one-hour history of noisy and abnormal breathing
after a choking episode while he was eating a chocolate and almond bar.
He was able to speak and drink fluids without difficulty.
Exam: VS T36.8, P200 (crying),
R28 (crying), oxygen saturation 99% in room air. He appeared alert, with
no signs of respiratory distress. He was able to speak, had no cyanosis,
no drooling, and no dyspnea. His lung sounds showed mild wheezing with
possible mild inspiratory stridor. An albuterol aerosol was administered
but no improvement was noted. A chest radiograph was ordered.
View CXR.
PA
Click
here for a better picture
Lateral
Click
here for a better picture
Questions:
- Are any foreign bodies
visible on this radiograph?
- Are there any subtle findings
on this radiograph to suggest a foreign body?
- Are there other radiologic
procedures that can be done to try to identify a foreign body?
- Is an invasive procedure
necessary or indicated at this point, i.e., bronchoscopy?
This CXR is within normal limits;
however, when a clinical suspicion of an airway foreign body is present,
a standard PA and lateral CXR are an insufficient evaluation. A lateral
neck film should be obtained to examine the upper airway for evidence of
swelling or foreign body. Decubitus films and/or expiratory films should
also be obtained to look for evidence of air trapping.
View supplementary radiographs.
Lateral neck
Click
here for a better picture
Click
here for a better picture
Left Lateral Decubitus
Click
here for a better picture
Right Lateral Decubitus
Click
here for a better picture
What is your Diagnosis?
Click here
for Case 8 Answers
Loren Yamamoto,
MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns
School of Medicine loreny@hawaii.edu
Medical
Information
