Aspirated foreign body

(Redirected from Foreign body aspiration)


  • Most common in young children (1-3 years old)
  • Consider in any child with respiratory symptoms
  • Object can be lodged in upper airway (20% of cases) or bronchus (80%)

Foreign Body Types

Clinical Features

Differential Diagnosis



Infectious Disorders


Neoplastic Disorders

  • Neoplasms/tumors

Allergic and Auto-Immune Disorders

  • Spasmodic/tracheobronchitis
  • Angioedema/Angioneurotic edema

Metabolic, Storage Disorders

  • Cerebral Gaucher's of infants (acute)
  • Tracheobronchial amyloidosis

Biochemical Disorders

Congenital, Developmental Disorders

Psychiatric Disorders

  • Somatization disorder

Anatomical or Mechanical

Vegetative, Autonomic, Endocrine Disorders


Chronic Pediatric Conditions

Pediatric stridor

<6 Months Old

  • Laryngotracheomalacia
    • Accounts for 60%
    • Usually exacerbated by viral URI
    • Diagnosed with flexible fiberoptic laryngoscopy
  • Vocal cord paralysis
    • Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
    • May have cyanosis or apnea if bilateral (less common)
  • Subglottic stenosis
    • Congenital vs secondary to prolonged intubation in premies
  • Airway hemangioma
    • Usually regresses by age 5
    • Associated with skin hemangiomas in beard distribution
  • Vascular ring/sling

>6 Months Old

  • Croup
    • viral laryngotracheobronchitis
    • 6 mo - 3 yr, peaks at 2 yrs
    • Most severe on 3rd-4th day of illness
    • Steeple sign not reliable- diagnose clinically
  • Epiglottitis
    • H flu type B
      • Have higher suspicion in unvaccinated children
    • Rapid onset sore throat, fever, drooling
    • Difficult airway- call anesthesia/ ENT early
  • Bacterial tracheitis
    • Rare but causes life-threatening obstruction
    • Symptoms of croup + toxic-appearing = bacterial tracheitis
  • Foreign body (sudden onset)
    • Marked variation in quality or pattern of stridor
  • Retropharyngeal abscess
    • Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension


Chest x-ray of an adult with obstructive pneumonia in the right lung evidenced by hypodense area. This is from a blockage in the respiratory tract leading to an infection distal to the obstruction.
CXR showing focal pneumonia in lower right lung lobe classic for aspiration.
  • CXR
    • Useful to confirm diagnosis, does not rule out
    • Negative in >50% of tracheal foreign bodies, 25% of bronchial foreign bodies[3], and may be missed if very small and/or radiopaque
    • Inspiratory/expiratory films may show relative hyperinflation proximal to obstruction on end-expiration
    • Consider lateral decubitus films on right and left side


Complete Airway Obstruction

  • If conscious: Heimlich maneuver, chest thrusts (obese or pregnant patients), back-blow/chest thrust (infants)
  • If object visible, remove manually (don't push it further into airway!)
  • Laryngoscopy, remove visualized object with Magill forceps
  • If unsuccessful, bag-valve mask or intubate (may dislodge object and improve situation to partial or more distal obstruction)
  • If unable to intubate, may need cricothyrotomy (though will not help if obstruction distal to cricothyroid)

Partial Obstruction

  • Supplemental O2
  • Allow patient to assume position of comfort
  • Monitor closely
  • May need rigid bronchoscopy to remove
  • Consider consulting ENT, anesthesia (inhalational induction will decrease risk of pushing foreign body into harder-to-reach area)
  • Post-removal: consider dexamethasone, bronchodilators and/or racemic epinephrine, and antibiotics for pneumonia


See Also

External Links


  1. Vocal Cord Dysfunction on Internet Book of Critical Care
  2. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004
  3. Zerella JT, Dimler M, McGill LC, Pippus KJ: Foreign body aspiration in children: value of radiography and complications of bronchoscopy. J Pediatr Surg 33: 1651, 1998.