Pediatric FB Ingestion & Aspiration

Heather Patterson PGY4

August 14, 2008

• Identify presentation of FB ingestion and aspiration

• Radiological features of FB ingestion and aspiration

• Xrays

Objectives

• 2005 USA Poison Centre reporting– 111,000 ingestions <19yo in 2000– Variety of items:

• Most common: coins• Large food items• Toys• Pins/batteries

Epidemiology - FB Ingestions

• Clinical picture esophageal FB:– Proximal esophagus:

• Cough• Stridor • Respiratory distress

– Mid and distal esophagus:• Pain• Drooling• Dysphagia

Ingestions

• What is the typical orientation of an esophageal FB?

• Why?

Radiology

• What are 4 common locations for esophageal FB?– cricopharyngeus– thoracic inlet– mid esophagus– LES/GE junction

Ingestions

• Symptomatic - immediate removal• Asymptomatic

– If below thoracic inlet, re-xray in 12-24h– Allow child to eat and drink– If passes into stomach, re-xray in 2-3

weeks unless FB detected in stool

Management and Followup

• USA 17000 ED visits <14y– 55-75% are children <4yo– 2900 deaths annually

• Common items:– Food ie peanuts– Parts of toys

FB Aspiration

• Clinical presentation:– History of choking spell– Cough, wheeze– Airway compromise

• On exam:– Decreased breath sounds 50%– Localized wheezing 40%– No findings 40%

FB Aspiration

• Hypopharynx 5%• Larynx/trachea 12%• Bronchi 83%

– Right mainstem 43%– Left mainstem 24%– Right segmental bronchi 22%– Left segmental bronchi 11%

FB Aspiration

• Approach:– Is there a radio-opaque FB on Xray?– Are there indirect signs of FB aspiration

on the PA and Lateral xray?– Have you ordered additional radiological

views to help visualize indirect signs of FB aspiration?

FB Aspiration - Radiology

• Most items are radiolucent• Look for indirect signs of aspiration

– Help our radiologists by letting them know you are specifically looking for signs of aspiration

FB Aspiration- Radiology

• CXR:– Atelectasis 22%– Mediastinal shift 13%– Radio-opaque FB 10-13%– Normal 10-20%

• Are there other views you would like to do?– Insp/exp views– Decubitus views

FB Aspiration

• What do you expect to see with an insp/exp film with an aspirated FB?

• Hyperinflation of the affected side• Why does this happen?

– Ball-valve mechanism

FB Aspiration

• What do you expect to see with a decubitus film with an aspirated FB?

• Normally, the dependent side has smaller lung volumes

• If the volume appears to be the same as the nondependent side, this is suggestive of a FB

FB Aspiration

Expiratory CXR