_The asthmatoid wheeze_ has been found by the author a valuable
confirmatory sign of bronchial foreign body. It is a wheezing heard by
placing the observer's ear at the open mouth of the patient (not at
the chest wall) during a prolonged forced expiration. Thomas McCrae
elicits this sign by placing the stethoscope bell at the patient's
open mouth. The quality of the sound is dryer than that heard in
asthma and the wheeze is clearest after all secretion has been removed
by coughing. The mechanism of production is, probably, the passage of
air by a foreign body which narrows the lumen of a large bronchus. As
the foreign body works downward the wheeze lessens. The wheeze is
often so loud as to be heard at some distance from the patient. It is
of greatest value in the diagnosis of non-roentgenopaque foreign body
but its absence in no way negates foreign body. Its presence or
absence should be recorded in every case.
_Prolonged bronchial obstruction_ by foreign body is followed by
bronchiectasis and lung abscess usually in a lower lobe. The symptoms
may with exactitude simulate tuberculosis, but this disease should be
readily excluded by the basal, unilateral site of the lesion, absence
of tubercle bacilli in the sputum, and roentgenographic study. Chest
examination in the foreign body cases reveals limitation of expansion,
often some retraction, flat percussion note, and greatly diminished or
absent breath-sounds over the site of the pulmonary lesion. Rales vary
with the amount of secretion present. These physical signs suggest
empyema; and rib resection had been done before admission in a number
of cases only to find the pleura normal.
ROENTGENRAY STUDY IN FOREIGN BODY CASES
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