1、 Foreign body aspiration can result a spectrum of changes,from minimal symptoms,to respiratory compromise,failure,and even death.Etiology Foreign body aspiration is most common in children aged 6 months to 4 years.They lack molars for proper grinding of food.They tend to be running or playing at the
2、 time of aspiration.They tend to put objects in their mouth more frequently.They lack coordination of swallowing and glottic closure.Etiology Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Mental retardation Alcoholism Psychos
3、es Neurologic disorders A drawing pin in the left main bronchus A peanut in the right main bronchusAnatomy Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.The diameter of the right main bronchus is larger than the left.The angle of divergence from the trach
4、eal axis is smaller on the right.Airflow through the right lung is greater than through the left.The carina is more likely to be located to the left of midline rather than to the right.Pathophysiology Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe.Peanuts are
5、 by far the most commonly aspirated material in children,followed by organic material such as sunflower seeds,pieces of vegetables,and hazelnuts.In adults,vegetable matter,meat,and bones rank highest,followed by dental and medical appliances.Aspiration of teeth after trauma is observed occasionally.
6、Clinical Features Tracheal foreign bodies An audible slap heard at the open mouth during cough.Palpable slap with respirations.Asthmatoid wheeze heard with the ear at the patients mouth.Clinical FeaturesMediastinal shift.Their progress depends upon their size and shape.Vegetable matter tends to be t
7、he most common airway foreign body;peanuts are the most common food item aspirated.A drawing pin in the left main bronchusNon-vegetable foreign bodies.They tend to put objects in their mouth more frequently.Clinical FeaturesAtelectasis.They tend to put objects in their mouth more frequently.Depend u
8、pon whether the foreign body is of non-vegetable or of vegetable nature.Vegetable foreign bodiesRemoval of the foreign bodyMediastinal shift.A drawing pin in the left main bronchusAn audible slap heard at the open mouth during cough.Airflow through the right lung is greater than through the left.Asy
9、mptomatic phase-Subsequent lodging of the object with relaxation of reflexes that often results in a reduction or cessation of symptoms,lasting hours to weeks.5 days after removalClinical FeaturesClinical Features Bronchial foreign bodies Three distinct stages of a foreign body accident:Initial phas
10、e-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.Complications phase-Foreign body producing erosion or obstr
11、uction leading to pneumonia,atelectasis,or abscess.Clinical Features Initial symptoms Cough and dyspnoea occur at the time of accident.Bloodstained expectoration is sometimes present.Clinical Features General symptoms Cough with or without dysponea.Expectoration.Asthmatoid wheeze.Clinical Features S
12、pecial symptoms Depend upon whether the foreign body is of non-vegetable or of vegetable nature.Clinical Features Non-vegetable foreign bodies.Their progress depends upon their size and shape.Little or no inflammatory reaction occurs in the bronchial mucosa at first.Granulations may form later and c
13、ause haemoptysis.Cough,after its initial presentation,disappears but it returns if the object changes position.Atelectasis occurs if the lobe of the lung is completely obstructed,with subsequent danger of infection and the formation of a lung abscessClinical FeaturesClinical Features An obstructive
14、emphysema occurs if a lobe is only partially obstructed.inspirationexpirationClinical Features Vegetable foreign bodies Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.There is always an intense inflammatory reaction of the trachea and
15、 bronchial mucosa.This-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Symptoms of acute tracheitis and bronchitis may be present.Clinical Features Imaging Studies:Posteroanterior and lateral chest radiographs are an adjunct to the history and physical exami
16、nation in patients in whom foreign body aspirations are suspected.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.Clinical Features X-ray Radiopaque foreign body.Atelectasis.Obstru
17、ctive emphysema.Mediastinal shift.A patch of pneumonitis.Radiopaque foreign bodyThree distinct stages of a foreign body accident:Initial phase-Choking and gasping,coughing,or airway obstruction at the time of aspirationNeurologic disordersForeign body aspiration is most common in children aged 6 mon
18、ths to 4 years.Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.Non-vegetable foreign bodi
19、es.Clinical FeaturesThere is always an intense inflammatory reaction of the trachea and bronchial mucosa.Clinical FeaturesClinical FeaturesMediastinal shift.Clinical FeaturesPulse oximetry.Clinical FeaturesClinical FeaturesA drawing pin in the left main bronchus5 days after removal5 days after remov
20、alCough and dyspnoea occur at the time of accident.Pulse oximetry.Atelectasis.Emphysema3 days after removal Mediastinal shift.Complete atelectasis of the left lung,with a mediastinal shift towards the left lung.A patch of pneumonitis.Emphysema5 days after removalTreatment Initial supportive therapy
21、Oxygen administration.Cardiac monitor.Pulse oximetry.Antibiotics and steroids.Removal of the foreign body Removal of the foreign body Removal through a bronchoscope.Removal by thoracotomy.Tracheostomy.TreatmentTreatment Removal through bronchoscope Tracheostomy Tracheostomy may be necessary if oedem
22、a of the larynx develops,either before or after bronchoscopy.TreatmentThey tend to put objects in their mouth more frequently.Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe.Adults who are unable to protect the airway,are also at risk of aspiration due to decr
23、eased airway protective mechanisms.Mediastinal shift.Clinical FeaturesClinical FeaturesThis-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Aspiration of teeth after trauma is observed occasionally.They lack molars for proper grinding of food.An audible slap
24、 heard at the open mouth during cough.Vegetable foreign bodiesVegetable foreign bodiesClinical FeaturesThe diameter of the right main bronchus is larger than the left.Removal through a bronchoscope.Non-vegetable foreign bodies.The foreign body is too large to remove by bronchoscope.The foreign body
25、is too large to remove by bronchoscope.Little or no inflammatory reaction occurs in the bronchial mucosa at first.5 days after removalClinical FeaturesMediastinal shift.Imaging Studies:Removal by thoracotomy.They tend to put objects in their mouth more frequently.Symptoms of acute tracheitis and bro
26、nchitis may be present.Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.Cough and dyspnoea occur at the time of accident.Vegetable foreign bodiesNeurologic disordersObstructive emphysema.Most foreign bodies lodged distal to the larynx a
27、nd trachea in the right mainstem bronchus.Vegetable matter tends to be the most common airway foreign body;peanuts are the most common food item aspirated.Clinical FeaturesComplete atelectasis of the left lung,with a mediastinal shift towards the left lung.Pulse oximetry.Mental retardationClinical F
28、eaturesClinical FeaturesThey tend to put objects in their mouth more frequently.Vegetable foreign bodiesThey tend to put objects in their mouth more frequently.Removal by thoracotomy The foreign body is small and locate in the lower-lobe bronchus.The foreign body is too large to remove by bronchosco
29、pe.TreatmentEtiology Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Mental retardation Alcoholism Psychoses Neurologic disordersClinical Features Non-vegetable foreign bodies.Their progress depends upon their size and shape.Li
30、ttle or no inflammatory reaction occurs in the bronchial mucosa at first.Granulations may form later and cause haemoptysis.Cough,after its initial presentation,disappears but it returns if the object changes position.Clinical Features Vegetable foreign bodies Vegetable matter tends to be the most co
31、mmon airway foreign body;peanuts are the most common food item aspirated.There is always an intense inflammatory reaction of the trachea and bronchial mucosa.This-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Symptoms of acute tracheitis and bronchitis may
32、 be present.Clinical Features Imaging Studies:Posteroanterior and lateral chest radiographs are an adjunct to the history and physical examination in patients in whom foreign body aspirations are suspected.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and
33、hyperinflation on expiration with a foreign body obstructing the bronchus.Mediastinal shift.Little or no inflammatory reaction occurs in the bronchial mucosa at first.Initial phase-Choking and gasping,coughing,or airway obstruction at the time of aspirationClinical FeaturesTheir progress depends upo
34、n their size and shape.Little or no inflammatory reaction occurs in the bronchial mucosa at first.Palpable slap with respirations.Their progress depends upon their size and shape.An audible slap heard at the open mouth during cough.5 days after removal3 days after removalTracheostomy may be necessar
35、y if oedema of the larynx develops,either before or after bronchoscopy.Expectoration.Vegetable foreign bodiesNon-vegetable foreign bodies.Clinical FeaturesBronchial foreign bodiesAntibiotics and steroids.Radiopaque foreign bodyGranulations may form later and cause haemoptysis.Palpable slap with resp
36、irations.Antibiotics and steroids.Little or no inflammatory reaction occurs in the bronchial mucosa at first.Pulse oximetry.3 days after removalThey tend to be running or playing at the time of aspiration.Clinical FeaturesVegetable foreign bodiesNon-vegetable foreign bodies.Cough and dyspnoea occur
37、at the time of accident.Mental retardationMental retardationRemoval through bronchoscopeAn audible slap heard at the open mouth during cough.Non-vegetable foreign bodies.A patch of pneumonitis.A drawing pin in the left main bronchusClinical FeaturesTheir progress depends upon their size and shape.No
38、n-vegetable foreign bodies.Complete atelectasis of the left lung,with a mediastinal shift towards the left lung.Neurologic disordersThree distinct stages of a foreign body accident:Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Treatment Removal through bronchoscope
