Cuerpos Extraños En Via Aerea 2010

Abstract:
Foreign body aspiration occurs frequently and is a leading cause of
pediatric morbidity. At the time of
presentation for care, children may
be asymptomatic. A high index of
suspicion is therefore needed to
make the diagnosis. Radiography
may aid in establishing the diagnosis but cannot exclude a radiolucent airway foreign body.
Bronchoscopy remains the definitive method fordiagnosis and the
therapy of choice for removal of
airway foreign bodies.

Keywords:
foreign body; children; aspiration;
choking; airway obstruction;
fluoroscopy; bronchoscopy

UT Southwestern Medical Center, Children's Medical Center, Dallas, TX 75235.
Reprint requests and correspondence:
Geetanjali Srivastava, MD, MPH, FAAP,
1935 Medical District Dr, Dallas, TX
75235.geetanjali.srivastava@utsouthwestern.edu
1522-8401/$ - see front matter
© 2010 Elsevier Inc. All rights reserved.

Airway Foreign
Bodies in
Children
Geetanjali Srivastava, MD, MPH

F

oreign body aspiration and ingestion are the leading
causes of unintentional injury in children younger than 1
year. Most foreign body (FB) aspirations occur in
children younger than 3 years and represent 78% to
89% ofthe reported cases in the United States.1,2 In 2007, there
were 3700 deaths related to inhalation or ingestion of food or
other objects obstructing breathing; and most of those occurred
outside of the hospital.3 There are several characteristics that
place children at higher risk for aspiration: children begin to
explore the world via the oral route by placing objects in their
mouth, arevery active and playful while eating, and do not have
cuspid molars to chew food sufficiently.4
Organic matter is most frequently aspirated. Peanuts are the
most common food aspirated, and balloons are the most common
nonfood item aspirated. 5 Other foods commonly aspirated
include popcorn, nuts, seeds, hot dogs, vegetable matter, and
bones. Inorganic items include toy parts, marbles, crayons,pen
caps, tacks, pins, paper clips, nails, screws, bullets, and casings.4
In adults, aspirated FBs are more commonly found in the right
bronchial tree. In recently published pediatric studies, the sites of
FB lodgment were the right bronchial tree in 54% to 55%, the left
side in 19% to 46%, and the trachea in 6% to 17%.2,6-8 A study with
the largest number of patients (N = 2165) reported nosignificant
difference in lodgment between the right side and left side.9

PRESENTATION
Aspirated FBs may be expectorated by coughing, may partially
or completely occlude the airway, or may remain in the airway
without causing significant obstruction.5 Diagnosis of a partial
obstruction may be delayed for weeks to months and sometimes
years. There are innumerable reports of children beingmisdiagnosed with upper respiratory tract infections, bronchiolitis, pneumonia, or asthma who are eventually diagnosed with
AIRWAY FOREIGN BODIES IN CHILDREN / SRIVASTAVA • VOL. 11, NO. 2 67

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FB aspiration after failing multiple rounds of
medical therapy (Figure 1).10 Children who present with signs and symptoms ofwheezing or
pneumonia some time after the initial choking
event and have positive radiographic findings
should be referred to a specialist for rigid or
flexible bronchoscopy or advanced imaging.5
Patients presenting immediately after an aspiration usually present with sudden onset of choking,
cough, and shortness of breath. Other signs and
symptoms that may be present include neck and/orthroat pain, stridor, dyspnea, wheezing, hoarseness,
perioral cyanosis, retractions, or rhonchi. Many
patients have only some or none of these signs and
symptoms. These early symptoms resolve when the
mucosal cough receptors accommodate. 5 If an
airway FB lodges near the glottic inlet, the signs
and symptoms may include acute airway distress,
hoarseness, and stridor. The classic triad of...