Inhaled foreign bodies usually occur in children (<4 years old) and the elderly (>70 years old). It usually presents acutely due to obstruction of the airway. However, 1/3rd of cases present within a few days of inhalation.
Aspiration of a foreign body is most likely to end up in the right main bronchus (and right lower lobe of the lungs) as is more vertical, wider and shorter than the left main bronchus.
😷 Presentation
Symptoms and signs may vary depending on the type of foreign body and the location of the aspiration.
Some symptoms of foreign bodies in the larynx or trachea are:
- Stridor
- Voice changes (dysphonia)
- Choking
- Cyanosis
- Dyspnoea
- Tachypnoea
- Pneumonia
- Coughing/choking
🚩 Stridor
🚩 Dysphonia
🚩 Drooling
🚩 Mediastinal widening
🔍 Investigations
A full history (if possible) will be very insightful as to the nature of the foreign body and its potential location.
- 🥇 CXR is usually first-line to assess for foreign bodies in the airways, however it is not the most sensitive.
- 🏆 CT scan is the gold standard. However, foreign bodies can be mistaken for soft-tissue tumours as well.
- If the inhaled foreign body is within the nasal cavity a simple thudicum and inspection might be able to detect it.
🧰 Management
- Heimlich manoeuvre can be tried, along with encouraging coughing.
- If the patient is unconscious, we need to:
- Secure the airway.
- Remove the foreign body - we can use Magill forceps if it is in the oropharynx region.
- If in the trachea and main bronchus then bronchoscopy is needed.
Foreign bodies that are ingested often pass through without any complications. However, if it gets lodged in the oesophagus, it can cause some serious issues.
It is important to remember that the oesophagus has 4 natural constrictions:
- Cricopharyngeus - C6
- Aortic arch - T4
- Left main bronchus - T5
- Oesophageal hiatus - T10
😷 Presentation
Once again it depends on the nature of the ingested foreign body (sharp or soft) but some features may be:
- Dysphagia - if the patient cannot swallow their own saliva, it is often a serious sign.
- Drooling
- Chest pain
- Sepsis features
- Coughing
🔍 Investigations
A full history (if possible) will be very insightful as to the nature of the foreign body and its potential location.
If at the level of the cricopharyngeus, patients can reliably locate the site. A flexible nasoendoscope may be used to examine the area.
If in the oropharynx we can use a tongue depressor to identify it.
🥇 X-ray - neck, chest, abdomen.
🧰 Management
Management also depends on the nature of the foreign body. However, we need to stabilise an unstable patient first.
- 🥇 Flexible nasal endoscopy is usually a first-line management choice.
- Surgical removal may be indicated in some cases
The incidence of button battery ingestion is increasing in children. This is an issue as a lodged battery in between tissue completes a circuit and allows the flow of current which can generate hydroxide radicals, leading to burn, necrosis, fistula formation, perforation quite rapidly. It is life threatening and needs immediate removal.
It is seen radiologically as a circular opaque object with a halo.
