Radiographic and Other Studies

1. Plain chest x-ray. In suspected lower airway foreign body aspirations, this should be the first x-ray ordered. It frequently reveals unilateral aeration disturbance such as air trapping ("ball-valve" phenomenon), atelectasis (complete obstruction), or consolidation. Many foreign bodies are not visualized on plain x-rays because they are nonradiopaque, but the aforementioned findings will suggest aspiration.

2. Inspiratory and expiratory films. May be required if plain film is not revealing. Often these additional films show unilateral air

trapping. In young children who cannot cooperate for these views, lateral decubitus films are a helpful adjunct. With an obstructed lung, the air that is trapped prevents the lung from collapsing and it does not become smaller in the dependent decubitus position.

3. Fluoroscopic airway exam. Rarely required, but if so, it can be diagnostic if differential ventilation of the lungs causes mediastinal shifting during respiration.

4. Soft tissue lateral neck x-ray. Indicated if an upper airway foreign body is suspected. Radiopaque objects are readily seen. Complications of nonradiopaque foreign bodies may be visualized.

5. Endoscopy (laryngoscope, bronchoscopy). Useful for diagnosis and treatment. Ideally should be performed during the day with pediatric airway specialists present.

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