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Age: 1

Sex: Male

Indication: Wheezing

Save ("V")

Case #18


Findings

  • Asymmetric hyperinflation of the left lung
  • Right side down decubitus view shows appropriate volume loss in the right lung
  • Left side down decubitus view shows persistent hyperinflation of the left lung


Diagnosis

  • Aspirated radiolucent foreign body

Sample Report

Asymmetric hyperinflation of the left lung with demonstration of air trapping on decubitus views, concerning for an aspirated radiolucent foreign body.

No focal airspace disease, pleural effusions, or pneumothorax.

Normal size and contour of the cardiothymic silhouette.


Discussion

  • Most aspirated foreign bodies are radiolucent
  • Foreign bodies cause obstruction via a ball-valve mechanism, allowing air to pass during inspiration but preventing air flow during expiration (when the airway is narrower)
  • Central airway obstruction leads to atelectasis in adults (because of well-developed communications between pulmonary lobules) and air trapping in children (especially young children who have underdeveloped interlobular communications)
  • Obtaining lateral decubitus views increases the sensitivity for detecting lower airways obstruction, so obtaining decubitus views is a good next step if there is asymmetric inflation of the lungs


Images

Asymmetric hyperinflation of the left lung. Right side down decubitus view shows expected volume loss in the right lung with rightward mediastinal shift. Left side down decubitus view shows minimal if any change in volume of the left lung, indicating air trapping.

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