Jonathan Gordon, M.D., Ph.D.

March 09, 2005

Discussion

Airway obstruction is a common clinical scenario in the pediatric ER and proper interpretation of findings on chest xray is the key to diagnosis. The episode of ingestion may or may not be known and the majority (97%) of foreign bodies are nonradiopaque. Findings on conventional chest xray may be normal, or reveal increased or decreased lung volumes. This makes the use of maneuvers evaluating the lungs on chest xray during different phases of the respiratory cycle important. Such maneuvers may include inspiratory and expiratory views or lateral decubitus views on each side. The goal is to evaluate the possibility of bronchial obstruction by a foreign body which will manifest itself in a ball-valve effect allowing air into the lung on inspiration but trapping it on expiration. Diagnostic findings may be subtle or grossly abnormal. If the chest xray is positive, the next step is bonchoscopy to alleviate obstruction. A peanut was found within the right mainstem bronchus of this patient. The differential for a unilateral hyperlucent lung at this age includes Poland's syndrome, Swyer-James syndrome and pulmonary hypoplasia.

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