What initial tests are most appropriate for evaluating suspected foreign body aspiration?

The initial evaluation of suspected foreign body aspiration commonly involves imaging techniques that can quickly and effectively reveal any obstructions in the airways or lungs. Bilateral decubitus or inspiratory/expiratory chest films are particularly useful in this scenario as they allow for visualization of the lungs and can help identify foreign bodies, especially if they are radiopaque (such as metal).

These films can provide insight into whether air trapping or other abnormalities are occurring as a result of a foreign body. The inspiratory and expiratory films can specifically demonstrate differences in lung inflation, which is important in cases where a foreign body may obstruct airflow in one or both lungs. If an object is present, it can sometimes be seen against the background of the lung tissue, leading to a more expedient diagnosis.

Other imaging options, such as a CT scan of the chest, while highly sensitive and specific, are typically used after initial chest X-rays suggest a problem, primarily due to the higher radiation exposure and the cost associated with CT scans. Blood gas analysis and ultrasound of the lungs are not standard initial tests for this type of evaluation; rather, they serve different diagnostic purposes. Blood gas analysis can assess the degree of respiratory distress but does not specifically visualize foreign bodies, while ultrasound is