Foreign Body Aspiration: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
  • Inspection (viewing).
    • Skin, mucous membranes
    • Oral cavity
    • Larynx (larynx)
    • Pharynx (throat)
    • Abdomen (abdomen)
    • If the event was not observed but a small part is missed, the child’s ear canals and nostrils should also be examined!
  • Auscultation (listening) of the heart.
  • Examination of the lungs (due tosymptomatology and possible sequelae).
    • Auscultation (listening) of the lungs – symptomatology depends on the location of the foreign body:
      • Extrathoracic (outside the thoracic cavity/chest cavity) trachea (windpipe) and higher: inspiratory (during inspiration) stridor or respiratory arrest.
      • Trachea: inspiratory and expiratory stridor.
      • Bronchial: expiratory wheezing (noticeable breath sounds; unilateral/side difference), attenuated breath sound on affected side.
    • Bronchophony (checking the conduction of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs) [increased sound conduction due to pulmonary infiltration/compaction of the lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent: e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
    • Percussion (tapping) of the lungs [e.g., in emphysema; box tone in pneumothorax]
      • Hypersonoric (louder and higher sounding) tapping sound on the affected side in valve mechanism.
      • Hyposonorous (muffled) knocking sound in atelectasis (lack of ventilation of lung sections).
    • Vocal fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with pleural effusion, pneumothorax, emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
• ENT medical examination [due topossible differential diagnoses:
  • Epiglottis (epiglottitis).
  • Laryngeal clefts (laryngeal clefts)
  • Esophagotracheal fistulas – fistula (unnatural connection) between the esophagus (food pipe) and trachea (windpipe).
  • Retropharyngeal abscess – collection of pus that travels along between the cervical spine and the posterior pharyngeal wall]
• Pneumological examination [due todifferential diagnoses:
  • Bronchial asthma
  • Bronchiolitis – inflammation of the small branches of the bronchial tree, called bronchioles.
  • Bronchitis (inflammation of the mucous membranes in the bronchi), acute obstructive
  • Bronchitis, recurrent (recurrent).
  • Bronchitis, chronic
  • Pertussis (whooping cough)
  • Pseudocroup – laryngitis (inflammation of the larynx), which leads mainly to swelling of the mucous membrane below the vocal cords (stenosing laryngitis).
  • Tracheitis (tracheitis)]

  [due topossible secondary diseases:

  • Aspiration pneumonia (pneumonia) – if the contaminated foreign body remains in the airways.
  • Atelectasis (lack of ventilation of sections of the lungs).
  • Hemoptysis (coughing up blood)
  • Bronchiectasis (synonym: bronchiectasis) – persistent irreversible saccular or cylindrical dilatation of the bronchi; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and decreased exercise capacity
  • Bronchitis, chronic
  • Lung abscess (encapsulated collection of pus in the lungs).
  • Pneumothorax – collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura)
  • Stenosis (narrowing) due to granulation tissue or scars.
  • Hyperinflation of the bronchi – the inflow of air is not affected by the foreign body, but the outflow is
  • Obstruction of the major airways – leads to massive shortness of breath, cyanosis (bluish discoloration of skin and central mucous membranes, e.g. tongue), hypoxia (lack of oxygen supply to tissues), asystole (cardiac arrest), in the worst case death
  • In case of unrecognized foreign body aspiration:
    • Chronic cough
    • Recurrent (recurring) pulmonary (affecting the lungs) infections]

Square brackets [ ] indicate possible pathological (pathological) physical findings.