M Shareef, M Trotter, F Wilson
foreign body, haemoptysis, stridor, wheezing, x-ray
M Shareef, M Trotter, F Wilson. Asymptomatic Foreign Body Aspiration In A Young Adult: A Case Report. The Internet Journal of Emergency and Intensive Care Medicine. 2004 Volume 8 Number 2.
Foreign body aspiration is a well documented clinical scenario. However establishing the diagnosis can be challenging. A case of an asymptomatic aspiration of a significant foreign body is presented here.
A 33 yr old white male who was previously fit and well presented to the Accident & emergency department with the symptoms of foreign body sensation in the throat following a meal. He denied any problems with breathing or any difficulty with swallowing. He also denied any violent attacks of coughing or haemoptysis. Clinical examination was unremarkable. He was afebrile and breath sounds were equally heard bilaterally. Surprisingly soft tissue neck X-ray revealed a foreign body in the trachea. He underwent rigid endoscopy and a chicken bone was removed. Patient was discharged the following day.
The diagnosis and management of foreign body aspiration is extremely important. Missed or delayed diagnosis can result in respiratory difficulties ranging from chronic wheezing or recurrent pneumonia to life threatening airway obstruction or lung abscess.
Lemberg et al (3) reported the following symptoms
Physical examination may show no abnormalities in large proportion of these cases.
Mc Guirt et al (4) reported the following physical findings
Radiographic studies are essential in these cases. Standard chest X-ray is useful in locating foreign bodies (5). Metallic and other radio opaque foreign bodies are easily located. However around 10% of case may not show any abnormality (4). Inspiratory -expiratory mediastinal shifting and mediastinal shift towards foreign body is most consistent finding on chest X-ray. In children fluoroscopy is most useful. But even fluoroscopy has shown up to 45% of false negatives. Ultrasound, CT scan and Xenoradiographic examinations have been of limited success. As neither diagnostic methods nor clinical findings are uniform, decision to examine the patient endoscopically often a clinical decision based on history. An endoscope should be used to remove foreign bodies. It is imperative to examine entire airway for any other simultaneous foreign body.
Tracheobronchial foreign body aspiration should be strongly suspected based on history in children and neurologically affected adults (5). However young adults are no exception. Though the majority of patients can present dramatically with a foreign body in their airway, few can be stable with no airway compromise as demonstrated in our case. The only positive clinical finding was history and X-ray. We would suggest that anyone with a definite history of ingestion of foreign body should have lateral soft tissue X-ray of neck. If unremarkable on X-ray, then decision to examine under anesthesia by endoscopy is based on history and symptoms as often X-rays can be misleading.
Accident and Emergency department, Russels Hall hospital, Dudley, Midlands, UK
Mr.Shareef.M.M,7 Kiltongue cottages,Monklands Hospital,Airdrie. ML6 0JXMobile: 07884184962.Mail: email@example.com