see also: [[Foreign body ingestion]], [[Upper airway obstruction (paeds)]] ![[Pasted image 20240501001331.png]] ## Clinical features - increased work of breathing - asymmetrical chest movement - focal wheeze - reduced breath sounds (focal and usually unilaterally) - persistent dry cough - may be minor symptoms - FBs tend to lodge in the right main stem bronchus - Examination usually reveals a well child with mild to moderate respiratory distress. - The patient may have a cough. - Auscultation may reveal diminished air entry on one side compared to the other with or without unilateral wheeze. - In delayed presentations, there may be a fever and signs of collapse or consolidation if an FB has resulted in a segmental infection. **X ray:** - The majority of objects are radiolucent and radiological findings are those that are secondary to the physical presence of FB in airway - may be normal or signs of *unilateral hyperinflation* - good quality inspiratory and expiratory or right and left decubitous XR are helpful - if there is air-trapping, then the affected lung or parts of lung remain inflated in expiration or on lying on that side (eg left side down) - there may be segmental or lobar collapse distal to the FB, particularly with delayed presentation ## Indications for bronchoscopy two of the following: - history - coughing and choking episdoe and cyanosis or persistent cough after choking episode - exam - unilateral wheeze or unilateral ↓ air entry - investigations - hyperinflation on expiratory CXR or subsegmental