Imaging Case of the Week 412 Answer

Inspiratory chest x-ray does not reveal major abnormalities. The expiratory film does show subtle finding of hyperinflation of the right lung mid & lower lobes, silhouetted by the horizontal fissure. With the given history of carrot piece inhalation, one can expect not to visualise it on the x-rays as vegetable matters are not radio-opaque.

The child underwent emergency bronchoscopy procedure which revealed a piece of carrot stuck in the bronchus intermedius that was safely extracted.

In a child with suspected foreign body inhalation, one may be able to see –

  • radio-opaque foreign body (plastic toys, nuts, vegetable particles are radiolucent).
  • lobar collapse.
  • hyperinflation on the affected side due to air trapping especially on expiratory chest x-ray. Hyperlucency can be localised or diffuse and occurs due to a ball valve mechanism in the larger airways.

Reference : Grainger & Allison’s Diagnostic Radiology, 6th edition.