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Foreign body pneumonia — Clinical Guidelines

Overview

Foreign body pneumonia occurs when foreign bodies are aspirated into the lungs, leading to respiratory complications and potential systemic issues. Common aspirated objects include fish bones, small magnets, and button batteries, which can cause localized or widespread lung injury.

Diagnosis

Clinical Presentation: Nonspecific symptoms such as cough, fever, chest pain, and respiratory distress 7 8.

Imaging: Chest X-ray and CT scans are crucial for identifying foreign bodies and complications like pneumothorax, pneumonia, or perforation 7 8.

Radiographic Findings: Foreign bodies may appear as linear densities or calcified foci; complications like atelectasis or abscess formation should be ruled out 7 8.

Endoscopy: Useful for visualizing and removing foreign bodies in the upper airway or esophagus before they reach the lungs 18.

Management

Immediate Removal: Prompt endoscopic or surgical removal of aspirated foreign bodies to prevent pneumonia and other complications 18 26.

Supportive Care: Oxygen therapy, antibiotics if infection is suspected, and respiratory support as needed 7.

Magnet Ingestion: Special attention for rare earth magnets due to high morbidity; surgical intervention may be required 2 6.

Button Batteries: Immediate medical evaluation; endoscopic or surgical extraction if impacted; avoid inducing vomiting 4 13.

Special Populations

Pediatrics: Higher risk of complications from small objects like magnets and button batteries; vigilant monitoring and early intervention crucial 2 10 13.

Elderly: Increased risk of aspiration due to dysphagia; careful assessment and management of underlying conditions 18.

Key Recommendations

Prompt Imaging and Endoscopy for suspected foreign body aspiration to identify and remove objects before complications arise (Evidence: Moderate 7 8).

Specialized Care for Magnet Ingestion: Recognize high risk and seek immediate surgical intervention if multiple magnets or other metallic objects are involved (Evidence: Moderate 2 6).

Urgent Removal of Button Batteries: Ensure timely endoscopic or surgical extraction to prevent severe tissue damage and systemic complications (Evidence: Moderate 4 13).

Enhanced Surveillance in Pediatric Patients: Given higher risks associated with foreign body ingestion, implement rigorous monitoring and preventive education (Evidence: Expert opinion 10).

References

1 Sajjad MM, Shahzad H. Ingestion of Multiple Keys in a 12-Month-Old Infant: Management of Oropharyngeal Foreign Body. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2023. link 2 Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J et al.. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. Journal of pediatric gastroenterology and nutrition 2023. link 3 Chiu CC, Huang CY, Chang KM, Lin SC, Liu YH, Liao PH et al.. Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents. ORL; journal for oto-rhino-laryngology and its related specialties 2022. link 4 Houston R, Powell S, Jaffray B, Ball S. Clinical guideline for retained button batteries. Archives of disease in childhood 2021. link 5 Kappagantu V, Mishra PR, Ranjan AK, Aggarwal P, Agarwal A, G B. Mobile phone ingestion requiring endoscopic retrieval. The American journal of emergency medicine 2021. link 6 Powers E, Ohuabunwa E, Salehi PP, Baum CR. Small Rare Earth Magnets Adhered to Pharyngeal Tissue in a Pediatric Emergency Department Patient. The Journal of emergency medicine 2021. link 7 E Silva GS, Gomes NBN, Pacheco EO, Bezerra FMR, Nunes RB, Mcphee HL et al.. Emergency CT of abdominal complications of ingested fish bones: what not to miss. Emergency radiology 2021. link 8 Ichikawa S, Onishi H, Motosugi U. Computed Tomography Findings of Emergency Cases Resulting From Fish Bone Ingestion. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 2021. link 9 Wang W, Schneider GT, Strohl A. The Utility of the Maxillary Heuwieser for Oropharyngeal Foreign Body Removal Under Nebulized Local Anesthesia: A Case Series. Ear, nose, & throat journal 2021. link 10 Speidel AJ, Wölfle L, Mayer B, Posovszky C. Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017. BMC pediatrics 2020. link 11 Martí-Castellote C, López-González A, Trenchs Sainz de la Maza V, Curcoy Barcenilla A, Alsina Rossell J, Luaces Cubells C. [Consultations for digestive foreign bodies ingestion in a pediatric emergency department.]. Revista espanola de salud publica 2020. link 12 Hamzah HB, James V, Manickam S, Ganapathy S. Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency. Indian journal of pediatrics 2018. link 13 . Small batteries pose serious risk to children. Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association 2016. link 14 Joyamaha D, Conners GP. Managing Pediatric Foreign Body Ingestions. Missouri medicine 2015. link 15 Marçal N, Soares JB, Pereira G, Guimarães J, Gonçalves M, Godinho T. The management of ingested foreign bodies in an Ear Nose and Throat Emergency Unit: prospective study of 204 cases. Acta otorrinolaringologica espanola 2013. link 16 Sondhi V, Patnaik SK, Khullar A. Procedural sedation associated displacement of sharp oesophageal foreign body. BMJ case reports 2012. link 17 Saz EU, Arikan C, Ozgenç F, Duyu M, Ozananar Y. The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2010. link 18 Kumar S. Management of foreign bodies in the ear, nose and throat. Emergency medicine Australasia : EMA 2004. link 19 Nelson JF. Ingesting an onlay. A case report. Journal of the American Dental Association (1939) 1992. link 20 Mizrahi S, Eyal I, Shtamler B. Foreign body removal through an appendicostomy. Diseases of the colon and rectum 1990. link 21 Bazak I, Miller A, Uri N. Oculosympathetic paresis caused by foreign body perforation of pharyngeal wall. Postgraduate medical journal 1987. link 22 Ito Y, Ihara N, Sohma S. Magnetic removal of alkaline batteries from the stomach. Journal of pediatric surgery 1985. link80114-7) 23 Reddy MR, Thomas M. An unusual foreignbody (screw) in the pharynx. Medical journal of Zambia 1981. link 24 Morrow JS, Haycock CE, Lazaro E. The "swallowed bullet" syndrome. The Journal of trauma 1978. link 25 Sartory A, Trabant G. Endoscopic extraction of a perforating paperclip from the stomach. Endoscopy 1978. link 26 Kerlin P, Paull A. Removal of duodenal foreign body with endoscopic snare. The Medical journal of Australia 1978. link 27 Miederer SE. A snare for the endoscopic extraction of coins. Endoscopy 1977. link 28 Frimberger E, Kühner W. A new device for endoscopic foreign body extraction. Endoscopy 1976. link 29 Mangla JC, Desbaillets LG. Endoscopic removal of chicken gizzards by polypectomy snare in a patient with Nissen's fundoplication. The American journal of gastroenterology 1975. link

Foreign body pneumonia