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Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008

Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008. Objectives. Identify presentation of FB ingestion and aspiration Radiological features of FB ingestion and aspiration Xrays. Epidemiology - FB Ingestions. 2005 USA Poison Centre reporting

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Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008

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  1. Pediatric FB Ingestion & Aspiration Heather Patterson PGY4 August 14, 2008

  2. Objectives • Identify presentation of FB ingestion and aspiration • Radiological features of FB ingestion and aspiration • Xrays

  3. Epidemiology - FB Ingestions • 2005 USA Poison Centre reporting • 111,000 ingestions <19yo in 2000 • Variety of items: • Most common: coins • Large food items • Toys • Pins/batteries

  4. Ingestions • Clinical picture esophageal FB: • Proximal esophagus: • Cough • Stridor • Respiratory distress • Mid and distal esophagus: • Pain • Drooling • Dysphagia

  5. Radiology • What is the typical orientation of an esophageal FB? • Why?

  6. Ingestions • What are 4 common locations for esophageal FB? • cricopharyngeus • thoracic inlet • mid esophagus • LES/GE junction

  7. Management and Followup • Symptomatic - immediate removal • Asymptomatic • If below thoracic inlet, re-xray in 12-24h • Allow child to eat and drink • If passes into stomach, re-xray in 2-3 weeks unless FB detected in stool

  8. FB Aspiration • USA 17000 ED visits <14y • 55-75% are children <4yo • 2900 deaths annually • Common items: • Food ie peanuts • Parts of toys

  9. FB Aspiration • Clinical presentation: • History of choking spell • Cough, wheeze • Airway compromise • On exam: • Decreased breath sounds 50% • Localized wheezing 40% • No findings 40%

  10. FB Aspiration • Hypopharynx 5% • Larynx/trachea 12% • Bronchi 83% • Right mainstem 43% • Left mainstem 24% • Right segmental bronchi 22% • Left segmental bronchi 11%

  11. FB Aspiration - Radiology • Approach: • Is there a radio-opaque FB on Xray? • Are there indirect signs of FB aspiration on the PA and Lateral xray? • Have you ordered additional radiological views to help visualize indirect signs of FB aspiration?

  12. FB Aspiration- Radiology • Most items are radiolucent • Look for indirect signs of aspiration • Help our radiologists by letting them know you are specifically looking for signs of aspiration

  13. FB Aspiration • CXR: • Atelectasis 22% • Mediastinal shift 13% • Radio-opaque FB 10-13% • Normal 10-20% • Are there other views you would like to do? • Insp/exp views • Decubitus views

  14. FB Aspiration • What do you expect to see with an insp/exp film with an aspirated FB? • Hyperinflation of the affected side • Why does this happen? • Ball-valve mechanism

  15. FB Aspiration • What do you expect to see with a decubitus film with an aspirated FB? • Normally, the dependent side has smaller lung volumes • If the volume appears to be the same as the nondependent side, this is suggestive of a FB

  16. Expiratory CXR

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