Mandatory medical device diagnostics.
- X-ray of the thorax (radiographic thorax/chest), in two planes:
- An aspirated foreign body is rarely seen on radiograph; radiographic signs are often absent, therefore:
- Watch for secondary signs such as hyperinflation, inadequate ventilation, and lateral difference!
- From bronchial position side differences arise!
- A valve mechanism with hyperinflation is manifested on the affected side by increased radiolucency, rarefaction (reduction) of the vascular drawing, diaphragmatic depression, mediastinal displacement (abnormal displacement of the mediastinum / mediastinal cavity) to contralateral (opposite side).
- Atelectasis (lack of ventilation of lung segments) is manifested on the affected side by transparency reduction and homogeneous shadowing, increased vascular drawing, diaphragmatic protrusion, mediastinal displacement to the affected side.
- An aspirated foreign body is rarely seen on radiograph; radiographic signs are often absent, therefore:
- Esophagogram (esophageal swallow): imaging of the esophagus (esophagus) and the transition of the esophagus into the stomach (esophagogastric junction) using x-rays and an oral contrast agent containing iodine or barium – indications:
- Suspicion of fistula
- Suspicion of reflux (here: esophagogram with reflux testing).
- Bronchoscopy or laryngo-tracheo-bronchoscopy.
- During preparation for bronchoscopy, individuals should be monitored because the aspirated foreign body may swell, depending on the material (eg, legume, powder). Also, the foreign body may migrate further or slide deeper.
- First, a flexible bronchoscopy is performed.
- If a foreign body is detected, the procedure is switched to rigid bronchoscopy (under general anesthesia).
- Note: If history and clinical findings suggest a suspicion of foreign body aspiration, bronchoscopy should be performed in any case, even if the radiograph is without findings, to confirm the diagnosis and concomitant therapy.
- If necessary, spirometry (basic examination in the context of pulmonary function diagnostics).
As a rule, the child is not expected to be fasting at the time of endoscopy. Since the child’s life may be acutely threatened, the following risks must be weighed against each other on the part of the disciplines involved:
- Risk of total/subtotal airway obstruction due to the foreign body.
- Risk of respiratory exhaustion in the child
- Risk of secondary damage from the foreign body
- During emergency anesthesia induction, risk of regurgitation (backflow) of gastric contents and/or pulmonary aspiration in non-fasted infant
- Risk of performing the procedure with less than optimal team staffing (during emergency operation).
The following criteria can be used to evaluate endoscopy urgency:
- Fasting of the child should not be waited for (because of risk of complete airway obstruction) if:
- Acute event (<24 hours); and
- Foreign body in the upper airway – larynx (voice box), trachea (windpipe), and/or
- Child with acute dyspnea (shortness of breath) and/or
- Infant
- Acute event (<24 hours); and
- The child’s sobriety should be waited for if:
- Subacute (> 24 h) or chronic (> 2 weeks) event and.
- Foreign body in the lower airway without dyspnea (shortness of breath).
- Subacute (> 24 h) or chronic (> 2 weeks) event and.
