Images in Emergency Medicine

Article Outline

• Diagnosis
  • Foreign body aspiration
• Copyright

A 57-year-old woman with no significant medical history presented to our emergency department with shortness of breath and audible wheezing. Two hours before presentation, she had been conversing while eating a carrot when she felt as if she aspirated. In our hospital, she was dyspneic but acyanotic. On auscultation, she had inspiratory wheezing on the left side greater than the right side. Inspiratory and expiratory chest radiographs demonstrated mediastinal shift and air trapping in the left lung on expiration (Figure).

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• Figure. 

  Anteroposterior inspiratory (left) and expiratory (right) chest radiographs demonstrating mediastinal shift and lucency (arrows) in the expiratory radiograph. Used with permission of Tristan Hartzell, MD, Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA.

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Diagnosis 

Foreign body aspiration 

The patient was diagnosed with a foreign body aspiration and taken to the operating room. A flexible bronchoscopy was performed, and a large piece of carrot wedged in the proximal portion of the left main bronchus was removed. The patient had no significant issues postoperatively and was discharged home 1 day after her presentation.

A single inspiratory chest radiograph has a low sensitivity for diagnosing foreign-body aspiration acutely. The foreign bodies are frequently radiolucent, and atelectasis can take more than a day to develop. One diagnostic technique frequently used in children and adults unable to give a medical history is inspiratory and expiratory chest radiographs. Expiratory views are often able to better demonstrate air trapping than a single radiograph on inspiration. Signs include increased lucency, mediastinal shift, and a depressed diaphragm.