Medical Central Resource

Left bronchial foreign body (chicken) with total collapse
Hyperexpanded right lung which defla

Monica Medynski

3/19/97

Presentation

18 month old male in respiratory distress.

Imaging Technique

Plain X-ray

Imaging Findings

Film 1 : opacified left hemithorax and hyperlucent and hyperexpanded right lung
Film 2 : aided forced expiration

Diagnosis

Left bronchial foreign body (chicken) with total collapse
Hyperexpanded right lung which deflates with expiration

Discussion

Aspiration of foreign body into the tracheobrachial airway is a common cause of respiratory distress in children ages 6 months to 3 years. Radiographic features depend on the size, location, duration, and nature of foreign body. Foreign bodies in the airway can cause air trapping with hyperinflation, atelectasis, or no change in aeration of the affected lung. Most foreign bodies are nonopaque. The foreign body lodges in the bronchial tree more often on the right than the left. Films at full inspiration may appear normal or show a slightly hyperinflated lung. When a foreign body is suspected, expiratory films should be obtained. If a child is too young to cooperate a gloved hand against the abdomen can aid in getting a good expiratory film. Bilateral lateral decubitus films can be obtained when good expiratory films can not be obtained. When air trapping occurs, the affected lobe remains hyperlucent rather than deflating. In this case the right lung was hyperlucent secondary to compensatory hyperinflation rather that air trapping, demonstrating appropriate decrease volume with forced expiration. The abnormal lung was atelectatic in this patient. Fluoroscopic examination is valuable to detect air trapping. As the bronchial obstruction becomes more complete, atelectasis, pneumonia, or bronchiectasis may develop. Differential diagnosis for unilateral hyperlucent lung:

technical factors (e.g. lateral decentering)
chest wall abnormalities (e.g. absence of the pectoralis muscle)
pleural disease (e.g. pneumothorax)
congenital lobar emphysema
air trapping secondary to bronchial obstruction
pulmonary vascular abnormalities
parenchymal disease (emphysema or bronchiolitis obliterans)

Submitted by: Monica Medynski,Capt,USAF,MC,Wilford Hall Medical Center
Reviewed by: Debra Pennington,Maj,USAF,MC,Wilford Hall Medical Center

References

Caffey's Pediatric X-Ray Diagnosis