The Diagnosis of Foreign Bodies in the Lower Air Passages
The diagnosis of foreign bodies in the bronchi necessarily entails close correlation of an accurate history, physical examination, and stereoroentgenographic study of the lungs. It is often impossible to get a clear-cut history of something having been inhaled into the air passages, and the roentgenograms are occasionally misleading, especially in non-opaque foreign bodies. The purpose of this paper is to stress the diagnostic importance of a careful physical examination of the chest. The necessity of early diagnosis and removal in order to avoid complications such as abscess, bronchiectasis, and pulmonary gangrene is well known.
A positive history of a foreign body will be of the accidental entrance of some organic or inorganic substance into the trachea. Such a history may not be obtained, especially if the onset of symptoms is insidious. This is especially true in infants and very young children where a history of manipulating foreign matter about the upper respiratory tract cannot be obtained.
The manner of lodgment of the foreign body influences the symptoms to an important degree. This has been shown by the experimental work of Weinberg1 who demonstrated the different degrees of pathological changes produced by vegetable and inert types of foreign bodies. He observed that obstruction caused by inhaled vegetable matter plays little part in the early disturbance of tissue. However, bronchial obstruction develops later and the tissue change which results is similar to that produced by obstructing inert foreign bodies. At this stage, the degree of obstruction rather than the composition of the. . .