Answers:
The preferred imaging modality for suspected foreign body ingestion is?
A) Posteroanterior CXR
B) Posteroanterior and lateral plain films
C) Barium Swallow
D) Chest CT
Posteroanterior and lateral plain film is the modality of choice. Barium swallows are generally not indicated. CT scan is unnecessary and exposes the patient (often a child) to unneeded xrays. Lateral films are needed to help distinguish esophageal from airway foreign bodies. However, not all foreign bodies are radio opaque and a negative film cannot r/o a foreign body.
What is the classic appearance of a button battery on plain film?
The posteroanterior view may look similar to a coin, however a closer look and sometimes a lateral view may reveal a "double contour"
MC Question:
A foreign body aspiration that is present for a significant amount of time can cause a chronic cough and be misdiagnosed as what?
A) Pneumonia
B) Asthma
C) Croup
D) All of the above
E) None of the above, foreign bodies present acutely.
Free Response Question:
If a foreign body is aspirated it may cause a ball-valve effect in the bronchi which leads to --- or it can completely obstruct the bronchi leading to ---.
Quick Facts:
Treatment of Airway Foreign Bodies
-Rigid endoscopic removal under general anesthesia is preferred.
-Rarely, can be done in awake patient if older and cooperative.
-Should be addressed at time of presentation.
-An asymptomatic older kid w/ distal or midesophageal coin which has been there for less than 24hrs can be observed for 8-16 hrs for spontaneous passage. In young kids/coin present >24hrs/sharp/caustic foreign body one should not observe.
-After removal dexamethasone (.5-1.0 mg/kg) can be given postop to decrease edema.
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