Non-Opaque Foreign Bodies in the Air Passages

THE clinical features produced by a non-opaque foreign body in the air passages are very striking and quite different from those due to a metallic foreign body. The outstanding feature is the violence of the reaction produced by the presence of such a foreign body in the respiratory tract. This reaction may be produced by any organic foreign body ; but the peanut, being the most common, seems to be the most toxic, also. The reaction consists of trauma, edema, congestion, exudation (membranous at times), spasm, and toxemia. These secondary results of the foreign body, rather than the foreign body itself, are responsible for the symptoms, physical signs, and X-ray findings. For this reason the removal of the foreign body does not immediately cure the patient and the symptoms may persist for some time afterwards. In fact, the care of the patient after the extraction of the foreign body is often as important as the bronchoscopy itself. Eight of our twenty-six cases required intubation after the removal of the foreign body, and a tracheotomy was necessary in two others. Neither intubation nor tracheotomy has been needed in any of our metallic foreign body cases. Two years or under is the age of the patients in 90 per cent of these cases. As a rule, the younger the child the more serious is the reaction. Adults very rarely get peanuts, watermelon seeds, beans, or corn into their bronchi, and when they do, they are not as seriously ill as are children. The history to be obtained from the mother is of the greatest importance. When she tells of her baby choking on something and “swallowing it the wrong way,” our statistics show that she is right in 96 per cent of the cases. The medical adviser takes a large responsibility when, in spite of a positive history, he makes a diagnosis of “no foreign body,” because of the lack of physical signs. On the other hand, it takes a very good clinician to diagnose a foreign body when the history is negative. Pneumonia or laryngeal diphtheria are more apt to be diagnosed and treated for first, and a foreign body thought of later. Usually in a presentation of this subject, the authors have some new diagnostic data to offer. In this series of cases, we have discovered nothing which has not been fully and clearly described before. Our reason for presenting these cases is that in the majority of them less than forty-eight hours elapsed between the aspiration of the foreign body and its removal. Consequently, our series should be typical of the early roentgen findings in non-opaque foreign bodies in the air passages. The roentgen signs have been fully described by Manges, Jackson, Spencer, their co-workers and others. The signs described by them are familiar to all of you. 1. Unilateral emphysema on the affected side. 2. Flattening and limited motility of the diaphragm on the affected side. 3. Displacement of the heart and mediastinum toward the unaffected side.