1. Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008

4. Identify presentation of FB ingestion and aspiration Radiological features of FB ingestion and aspiration Xrays Objectives

5. 2005 USA Poison Centre reporting –111,000 ingestions <19yo in 2000 –Variety of items: Most common: coins Large food items Toys Pins/batteries Epidemiology - FB Ingestions

6. Clinical picture esophageal FB: –Proximal esophagus: Cough Stridor Respiratory distress –Mid and distal esophagus: Pain Drooling Dysphagia Ingestions

7. What is the typical orientation of an esophageal FB? Why? Radiology

8. What are 4 common locations for esophageal FB? –cricopharyngeus –thoracic inlet –mid esophagus –LES/GE junction Ingestions

9. Symptomatic - immediate removal Asymptomatic –If below thoracic inlet, re-xray in 12-24h –Allow child to eat and drink –If passes into stomach, re-xray in 2-3 weeks unless FB detected in stool Management and Followup

18. USA 17000 ED visits <14y –55-75% are children <4yo –2900 deaths annually Common items: –Food ie peanuts –Parts of toys FB Aspiration

19. Clinical presentation: –History of choking spell –Cough, wheeze –Airway compromise On exam: –Decreased breath sounds 50% –Localized wheezing 40% –No findings 40% FB Aspiration

20. Hypopharynx 5% Larynx/trachea 12% Bronchi 83% –Right mainstem 43% –Left mainstem 24% –Right segmental bronchi 22% –Left segmental bronchi 11% FB Aspiration

21. Approach: –Is there a radio-opaque FB on Xray? –Are there indirect signs of FB aspiration on the PA and Lateral xray? –Have you ordered additional radiological views to help visualize indirect signs of FB aspiration? FB Aspiration - Radiology

22. Most items are radiolucent Look for indirect signs of aspiration –Help our radiologists by letting them know you are specifically looking for signs of aspiration FB Aspiration- Radiology

23. CXR: –Atelectasis 22% –Mediastinal shift 13% –Radio-opaque FB 10-13% –Normal 10-20% Are there other views you would like to do? –Insp/exp views –Decubitus views FB Aspiration

24. What do you expect to see with an insp/exp film with an aspirated FB? Hyperinflation of the affected side Why does this happen? –Ball-valve mechanism FB Aspiration

25. What do you expect to see with a decubitus film with an aspirated FB? Normally, the dependent side has smaller lung volumes If the volume appears to be the same as the nondependent side, this is suggestive of a FB FB Aspiration

30. Expiratory CXR