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FB hyperinflation CXR — RACP Paediatrics MCQ

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HardRespiratoryFB hyperinflation CXRRACP Paediatrics

A 4-year-old choked on a grape and now has unilateral wheeze. Expiratory radiography shows left hyperinflation and rightward mediastinal shift; oxygen saturation is 96% and there is no stridor. What is the definitive next management step?

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Correct answer: B — Arrange urgent rigid bronchoscopy by an experienced airway team

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

E is correct. The choking event and unilateral ball-valve air trapping indicate a bronchial foreign body requiring urgent bronchoscopic removal by an experienced team. A partial bronchodilator response does not exclude aspiration. B risks distal displacement or complete obstruction. C adds radiation and delay when bronchoscopy is already indicated. D risks migration, infection and sudden airway compromise.

Reference: RCH Melbourne, Foreign bodies inhaled: https://www.rch.org.au/clinicalguide/guideline_index/Foreign_Bodies_Inhaled/