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Question
Patient: 11 month old with trouble breathing and color change after a family member sprayed air freshener. Symptoms have since resolved.
What are you concerned about in the attached xrays?
Answer
Answer: Radiolucent foreign body
Bilateral decubitus lateral films allow assessment of air trapping. The expectation is that the dependent lung will collapse partially in the normal patient. When a foreign body is present, there will be air trapping and hyperlucency in the dependent lung. In older patients, you can also obtain expiratory films to look for air trapping.
The patient had a food/mucus plug that was taken out of the right mainstem on bronchoscopy.
Foreign body aspiration is the 4th most common cause of accidental death in children younger than 3 years. Coughing and choking are the most common presenting symptoms.
CXRs are negative in > 50% of tracheal foreign bodies and 25% of bronchial foreign bodies.
More than 75% of foreign bodies in children less than 3 years are radiolucent.
Indirect signs of radiolucent foreign bodies include unilateral hyperinflation, atelectasis, consolidation and bronchiectasis (if presentation is delayed).
Bottom line: Consider bilateral lateral decubitus xrays in patients with a history concerning for foreign body.
References
Baram et al. Trachoebronchial Foreign Bodies in Children: The Role of Emergency Rigid Bronchoscopy. Global Pediatric Health. 2017: 1-5.