TABLE 2355 Signs and Symptoms of Foreign Body Aspiration versus Ingestion

It is crucial to obtain a careful history and a precise description of the foreign body ingested or aspirated. Careful questioning of the parents may uncover an episode of choking or vomiting that was dismissed at the time as insignificant. Although they are not always diagnostic, routine chest radiographs should be obtained. Because some foreign bodies may be very thin and poorly seen in one dimension, both anteroposterior and lateral radiographs are essential. Both inspiratory and expiratory films should be obtained. Changes related to inspiration and expiration are the most common abnormal findings, consisting of differential inflation or a shift of the mediastinum toward the object with inspiration. Atelectasis, hyperinflation, and aerophagia are radiographic findings consistent with foreign-body aspiration. 35

In contrast to foreign-body ingestions, all suspected foreign-body aspirations require bronchoscopic evaluation by a consulting otolaryngologist. See Chap 72 and

Chap, 129 and for discussions of foreign-body ingestion and aspiration.

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