Diagnostics

Neck x-ray (lateral view)

• Indications: suspected upper airway FB

• Findings

  • Radiopaque foreign objects may be visible.

  • Widened prevertebral shadow, loss of cervical lordosis (secondary signs)

• Indications: next management step after failed first-aid attempts to dislodge an upper airway FB

• Findings

  • Direct visualization of the FB

  • Potentially surrounding mucosal edema, abrasions, or blood

• Indications

  • Initial screening modality in suspected lower airway FBA

  • Exclusion of alternative diagnoses

• Views

  • PA, lateral, and expiratory

• Findings

  • FB may be visualized if radiopaque (∼ 25%).

  • Lung parenchyma changes suggestive of FBA are described in the table below.

• Disadvantages

  • False reassurance if chest x-ray is normal

  • Insufficient detail for planning removal of FB; further imaging usually necessary

• Indications

  • Second-line test in suspected lower airway FBA with a normal or inconclusive chest x-ray

  • To guide planned removal of FB

• Findings

  • Similar to chest x-ray

  • Additionally includes:

    • Focal bronchial wall thickening adjacent to the FB

    • Tree-in-bud opacities [28]

Bronchoscopy

Bronchoscopy is the gold standard diagnostic and therapeutic modality for a suspected lower airway FBA.

• Indications

  • Preferred modality in patients with signs of respiratory distress suspected to be due to a lower airway FB

  • Next step in stable patients high clinical suspicion of lower airway FBA despite inconclusive imaging.

• Findings

  • Direct visualization of the FB

  • Granulation tissue if localized irritation has occurred