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Foreign Body, Respiratory Tract 355

Foreign Body, Respiratory Tract Client Education
Sheet
VetBooks.ir Differential Diagnosis Diseases and Disorders

BASIC INFORMATION
○ Occlude nostrils one at a time, and listen
closely for airflow or watch for movement • Nasal FB (p. 1255)
Definition of an object (e.g., wisp of cotton, pet’s • Nasopharyngeal FB: polyp, granuloma,
Inhaled, penetrating, or migrating objects that hair) held in the path of airflow. neoplasia, rhinitis
cause obstruction, inflammation, or secondary ○ Hold a chilled glass microscope slide in front • Tracheal/bronchial FB: laryngeal paralysis,
infection of the respiratory tract of the nostrils, and observe for fogging. collapsing trachea, elongated soft palate,
○ Aspergillosis may erode turbinates and trauma, neoplasia, infection
Synonyms negate FB obstruction of airflow. • Lung or intrapleural FB: bronchopneumonia,
Migrating foreign body (FB), nasal FB, tracheal/ • Nasal discharge: unilateral, mucopurulent ± pyothorax from trauma or systemic disease,
bronchial FB blood tinge initially. It may be bilateral in pneumothorax, neoplasia.
cats, or with chronic erosion of nasal septum
Epidemiology (p. 1255). Initial Database
SPECIES, AGE, SEX • Possible ocular discharge • CBC
Dogs and cats of either sex, may be more Nasopharyngeal FB: ○ Neutrophilic leukocytosis ± left shift
prevalent in young animals • Stertor and toxic neutrophils, with pyothorax,
• Halitosis secondary bronchopneumonia, or severe
GEOGRAPHY AND SEASONALITY • Reverse sneezing secondary rhinitis
May be more common during hunting season • Acute onset of vomiting, retching, or gagging ○ Eosinophilia possible with tracheobron-
or in areas with oat/cereal fields or grass awns Tracheal/bronchial FB: chial grass awns
(foxtails) • Cough • Serum biochemistry profile and urinalysis
• Tachypnea often unremarkable
ASSOCIATED DISORDERS • Increased respiratory noise: stridor; high- ○ With pyothorax, may find hypoalbumin-
• Chronic intranasal FB: aspergillosis (p. 81) frequency wheeze with partial obstruction emia, hypoglycemia, or proteinuria.
or bacterial rhinitis (auscult trachea with stethoscope to localize • Coagulation profile (hemoptysis, epistaxis):
• Intratracheal FB: focal tracheal stenosis to trachea) unremarkable
(granuloma) • Dyspnea (inspiratory and/or expiratory); • Radiographs: findings other than radiopaque
• Bronchial FB: lobar pneumonia proportionate to obstruction FB may include
• If laryngeal or tracheal obstruction: noncar- • Cyanosis, collapse, or sudden death with ○ Nasal FB: increased intranasal soft-tissue
diogenic pulmonary edema (p. 836) severe obstruction opacity, local turbinate destruction (chronic)
• If penetration of esophageal FB through Intrathoracic FB: as for pyothorax (p. 857) ○ Tracheal FB: increased airway soft-tissue/
bronchus: bronchoesophageal fistulas fluid opacity on cervical or thoracic films,
• If FB migration into or through pleural space: Etiology and Pathophysiology noncardiogenic pulmonary edema if severe
pyothorax (p. 857) • Inhalation is the most common path of FB obstruction
entry for dogs. ○ Bronchial FB: ill-defined peribronchial
Clinical Presentation ○ Plant material (e.g., seeds, awns, grass, radiopacity, or
DISEASE FORMS/SUBTYPES depending on region) most common; may ○ Lung or bronchial FB: lung consolida-
• Rhinitis migrate into pleural space (pp. 797 and tion with secondary bronchopneumonia,
• Tracheitis/bronchitis or tracheobronchial 857). pneumothorax
obstruction ○ Other common FBs: stones, teeth, bone ○ Intrapleural FB
• Pyothorax (empyema) fragments, food ■ Focal pulmonary interstitial to alveolar
• Pneumonia • Nasopharyngeal FB is usually a bone in dogs. opacities, most common in caudal or
• Pneumothorax • In cats, FBs often lodge at nasal choanae accessory lobes
after flipping up over soft palate. ■ Pleural effusion, pleural thickening
HISTORY, CHIEF COMPLAINT • Sharp esophageal or gastric foreign bodies ■ Collapsed lung lobes
• Nasal FB: nasal discharge (p. 678), acute may migrate into lungs or pleural space. ■ Spontaneous pneumothorax may occur
sneezing, pawing at face, or other signs of • Local inflammatory reaction and contamina- with penetrating or migrating thoracic
discomfort tion may result in secondary bacterial or foreign bodies.
• Nasopharyngeal FB: stertor, sneezing, reverse fungal infection. • Pyothorax: inflammatory exudates (degener-
sneezing, halitosis with chronicity ate neutrophils ± bacteria) on cytology of
• Tracheal/bronchial FB: acute cough DIAGNOSIS pleural fluid obtained by thoracocentesis (p.
+/− respiratory distress, chronic cough, 1164). Macrophages and plasma cells increase
halitosis, hemoptysis, retching/vomiting Diagnostic Overview with chronicity.
possible, exercise intolerance or cyanosis if Respiratory FB is suspected based on acute onset ○ Commonly cultured organisms: obligate
severe obstruction, temporary or recurring of clinical signs or chronic focal disease that anaerobes (e.g., Fusobacterium), Nocardia
response to antibiotics in some chronic cases can be responsive to antibiotics on a recurring asteroides, Actinomyces in dogs, Pasteurella
• Intrathoracic FB: anorexia, lethargy, weight basis. Confirmation can be made by radiographs multocida in cats
loss, fever, increased respiratory effort/ (e.g., radiodense bone fragments in airway),
tachypnea, poor performance but endoscopy is often required. Migrating Advanced or Confirmatory Testing
intrathoracic grass awns should be suspected in • Intranasal FB may be visible with anterior
PHYSICAL EXAM FINDINGS sporting/hunting breeds with a history of cough rigid scope or posterior flexible scope,
Nasal FB: and fever that have focal pulmonary opacities, although nasal discharge may obscure view.
• Assessment of decreased air movement pleural effusion, and pleural thickening seen Nasal flushing removes discharge to improve
through one nostril on radiographs or CT. visualization and may flush out FB.

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