By

Tarek El Desoky
Prof. of Pediatrics
 Outlines
 Introduction and problem magnitude

 Etiology

 Pathophysiology

 Clinical presentation

 Differential Diagnosis

 Imaging study

 Management
 Introduction
In USA

FBA was responsible for 4,800 deaths in 2013,or 1

death per 100,000 children 0 to 4 years .

FBA is the fifth most common cause of unintentional-

injury mortality, but the leading cause of
unintentional-injury mortality in infantscinfhildren <
one year .
 Introduction
FBA is the great simulator of the chest !!! Why?
If the aspiration is not witnessed the child may
present with:
- persistent or recurrent cough
- persistent wheezing
- persistent or recurrent pneumonia
- lung abscess - focal bronchiectasis
- hemoptysis. - air leak syndrome
- unexplained stridor
 Frequency
 Most airway FB aspiration occur in children younger
than 15 years.

 Vegetable matter is the most common airway FB,

peanuts are the most common food item.

 The incidence of metallic foreign body aspirations,

particularly of safety pins, has decreased in frequency.

 Religiuos background!!
 Etiology
Children aged 1-3 years are the most susceptible:

They lack molars for proper grinding of food.

They tend to be running or playing at the time of

aspiration.
They tend to put objects in their mouth more

frequently.
They lack coordination of swallowing and glottis

closure.
 Pathophysiology

After FB aspiration occurs, it can settle into

3 anatomic sites:

 The larynx.

 The trachea.

The bronchi.
 Pathophysiology
Of aspirated FBs, 80-90% become lodged in the
bronchi.
 In adults, bronchial FBs tend to be lodged in the right main
bronchus:
 lesser angle of convergence compared to the left
 the location of the carina left of the midline.

 Equal frequency of right and left bronchial FBs in children.

Larger objects tend to become lodged in the larynx or

trachea.
 Pathphysiology
In general, aspiration of FBs produces the following 3
phases.
Initial phase:
 Choking and gasping, coughing, or airway obstruction (at
the time of aspiration)

Asymptomatic phase
 Subsequent lodging of the object with relaxation of reflexes
that often results in a reduction or cessation of symptoms,
(lasting hours to weeks.)

Complication phase:
 FB producing erosion or obstruction leading to pneumonia,
atelectasis or abscess.
 Clinical presentation

History:
Positive
Positive on interrogation
Negative
 Clinical presentation
Symptoms and signs:

Depends on the location of the FB:

 A large FB lodged in the larynx or trachea can produce

complete airway obstruction from either the
dimensions of the object or the resulting edema.

 Laryngeal foreign bodies present with airway

obstruction and hoarseness or aphonia.
 Clinical presentation

Tracheal FBs present either:

-- similarly to laryngeal FBs but without hoarseness or

aphonia.
-- demonstrate wheezing similar to asthma.

Bronchial FBs typically present with:

* cough *unilateral wheezing *decreased BS
but only 65% of patients present with this classic triad.
Patients may have normal
examination findings despite
having a foreign body within the
airway
 Differential Diagnosis
 Many of the signs and symptoms can be confused with
other clinical entities.

Reactive airway disease Empyema

Pneumonia Croup
Tracheobronchial tumor Bronchitis
Tracheomalacia Psychogenic cough
Bronchomalacia
 Imaging Studies

Suspected laryngeal FB:

 High-kilovolt AP and lateral radiographs of
the neck are the test of choice.

Suspected intrathoracic FB:

PA and lateral chest radiographs.
Principals:
 Radiopaque objects are visible, but radiolucent objects
(eg,plastic) are not.

 Chest radiographs may reveal obstructive emphysema,

atelectasis, or consolidation.

 Lateral decubitus chest films may be helpful in children in whom

the dependent lung remains inflated with bronchial obstruction
(normally, the dependent lung collapses).

 Chest radiographs (inspiratory and expiratory films)

demonstrate inflation on inspiration and hyperinflation on
expiration with a FB obstructing the bronchus.
 Expiration

Inspiration
 Normal chest x-ray does not
exclude foreign body aspiration
Prevention
Management :

Emergency management

Non emergency management.

 Rigid bronchoscopy
 Fibro optic bronchoscopy

No contraindication for bronchoscopy whenever

foreign body is suspected
Effective coughing Ineffective coughing

Crying or verbal
Unable to vocalize
response to questions

Loud cough Quiet or silent cough

Able to take a breath Unable to breathe

before coughing Cyanosis

Decreasing level of
Fully responsive
consciousness
 Effective coughing
No external maneuver is necessary.

Encourage the child to cough, and monitor

continuously.

If the child’s coughing is becoming, ineffective,

shout for help immediately and determine the
child’s conscious level.
 Ineffective coughing
Conscious

5 Back
Blows
 Ineffective
 Conscious
coughing
5 chest 5 Abd.
thrusts thrusts
 Ineffective coughing
Unconscious
 Diagram
Ineffective cough

Ineffective Unconscious
cough
Effective cough Conscious Open airway
Encourage
5 back blows 5 breaths
cough
Infant Start CPR
Check
5 chest thrusts
for deterioration
Child
to ineffective
5 abd. thrusts
cough
or relief of
obstruction