Inhalation of a foreign body into the larynx and respiratory tract.
Symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi.
Major causes of foreign body aspiration are altered mental status from alcohol or sedative use; seizure; neurologic disorders; trauma associated with a decreased level of consciousness; dental procedures; advanced or young age; and disorders associated with dysphagia and impaired cough reflex.
Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails.
Foreign body aspiration is the inhalation of a foreign body into the larynx and respiratory tract.
History and exam
Key diagnostic factors
- choking crisis
- unilateral decreased breath sounds
- unilateral wheezing
Other diagnostic factors
- intractable cough
- bilateral wheezing
- decreased level of consciousness (Glasgow coma score <9)
- age <4 years
- age >70 years
- bulbar dysfunction
- male sex
- cerebrovascular disease
1st investigations to order
- chest x-ray
Investigations to consider
- CT chest
Arjun B. Chatterjee, MD, MS, FACP, FCCP, FAASM
Professor of Medicine
Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease
Wake Forest University School of Medicine
ABC declares that he has no competing interests. His opinions are his own and do not represent those of his employers: Wake Forest University School of Medicine; US Department of Defense - United States Navy; US Department of Veteran’s Affairs.
Dr Arjun B. Chatterjee would like to gratefully acknowledge Dr Septimiu Murgu and Dr Henri Colt, the previous contributors to this topic. SM and HC declare that they have no competing interests.
Amber Young, BSc, MB ChB, FRCA
Consultant Paediatric Anaesthetist
Department of Anaesthesia
AY declares that she has no competing interests.
Momen M. Wahidi, MD, MBA
Division of Pulmonary, Allergy, and Critical Care Medicine
Assistant Professor of Medicine
Duke University Medical Center
MMW declares that he has no competing interests.
Pyng Lee, MD
Department of Respiratory and Critical Care Medicine
Singapore General Hospital
PL declares that he has no competing interests.
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