May 4, 2009

Inhaled Foreign Body

( CT chest with virtual bronchoscopy showing cut off in
left main bronchus with left lung collapse & shift of mediastinum)

Inhalation of foreign body (FB) is the commonest cause of acute respiratory distress in children. 'Peanuts' is the commonest FB to be inhaled. It is important that these type of objects are kept away from children< 5 yrs. The other FBs are metal pins, vegetative FB, plastic objects, seeds, pen tops etc.

Presentation: The child presents with acute onset of respiratory distress started with coughing, choking & may lead to cynosis & respiratory arrest. There may be h/o inhalation of FB if parents or relatives are around the child. This is an emergency situation.

Management: The child needs to be resuscitated first. If the child cant breath or make a sound, invert the child & give 3/4 forceful back slaps. The child may cough out FB. But if the child can breath or make a sound then this procedure should not be done as it may dislodge FB & increase the obstruction. The child needs to be shifted to the hospital as early as possible. X-ray of chest will show FB ( if it is radio opaque), portion of lung or whole lung may look overinflated, there may be collapse of lung & mediastinal shift. CT chest with virtual bronchoscopy will exactly locate radiolucent FB & help in uncertain cases. Bronchosopy & removal of FB is the definitive management.