After putting her 1-year-old boy (who puts virtually everything in his mouth) down for a nap, a mother failed to find one of the larger beads she used to make the custom jewelry she produces for sale. Two days later, the boy developed a cough and became feverish. What is likely to have happened to the bead, and where (anatomically) would you expect it to be found?

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Foreign Body ( FB ) Inhalation

the clinical picture of FB inhalation depends on : i- nature of the FB. ii- location of the FB. iii- degree ( severity ) of airway obstruction. iv- Time elapsed since inhalation.
An inhaled FB is either : a- Expelled : by cough reflex. b- Aspirated and lodged in larynx, trachea and bronchi.

Laryngeal FB :

i- Large FB : complete obstruction ------ suffocation, dyspnea, cyanosis , fatal outcome. ii- Small FB : partial obstruction ----- hoarseness, aphonia, stridor, croupy cough.

Tracheal FB :

i- General signs :
   cough, hoarseness, dyspnea, cyanosis.
ii- Characteristic signs :
   asthmatroid wheeze, audible slap, palpable thud
   ( dull sound )
   both slap and thud are caused by momentary 
   expiratory impaction of FB at subglottic level.

Bronchial FB :

 - age : mainly in preschool children ( 1 - 5 years ).
 - clinically :
   immediate ( initial symptoms ) : episodes of 
  gagging, choking, and paraoxysmal cough, 
  followed by 
  symptoms free period ( latent period )
  then stage of sequelae  ( complications ) : 
  symptoms depend on the degree of obstruction,
   nature of the FB and stage at which the patient 
   is seen.
   i- non - obstructive , non - irritating FB :
      few symptoms ( e.g. cough ).
   ii- Obstructive FB :
      a- slight partial obstruction ( bypass valve ) :
          wheezes 
      b- moderate partial obstruction ( ball valve ) :
          - obstructive emphysema.
          - hyperinflation.
          - decreased air entry.
          - wheezes.
      c- complete obstruction ( stop valve ) :
          atelectasis + infection 
           bronchiectasis
           lung abscess
           recurrent pneumonia.
    iii- Vegetable FB : e.g. peanut.
       leads to vegetal ( arachidic ) bronchitis ---------
       ------ cough, fever, dyspnea .
      and if prolonged : chronic suppuration.
 - commonest site of the Bronchial FB :
  i- more on RIGHT ( right main bronchus is shorter
     wider and more in line with trachea ).
  ii- if errect ------ apical segment of lower lobe.
 iii- if supine ------ posterior segment of upper lobe.