## Most Common Site of Foreign Body Lodgement in Pediatric Airway **Key Point:** The right main bronchus is the most common site of foreign body (FB) lodgement in children, accounting for 60–70% of cases. ### Anatomical Basis The right main bronchus is preferentially affected due to its anatomical characteristics: 1. **More vertical orientation** — The right main bronchus arises at a more vertical angle (20–30° from the midline) compared to the left (40–50°), making it more in line with the trachea. 2. **Wider diameter** — The right main bronchus has a larger calibre than the left. 3. **Straighter course** — The straighter path makes FB passage more likely during aspiration. ### Clinical Presentation & Imaging | Feature | Right FB | Left FB | | --- | --- | --- | | **Frequency** | 60–70% | 20–30% | | **CXR finding** | Right hyperinflation (air-trapping) | Left hyperinflation | | **Mechanism** | Gravity + anatomy | Less common path | **Clinical Pearl:** Unilateral hyperinflation on chest X-ray is a key diagnostic clue — it suggests FB in the ipsilateral main bronchus due to ball-valve obstruction (air enters during inspiration but cannot escape during expiration). ### Why Other Sites Are Less Common - **Larynx (10–15%):** Usually causes acute, severe airway obstruction; often presents with stridor and respiratory distress requiring emergency removal. - **Trachea (5–10%):** Can cause bilateral air-trapping; less common because the trachea is wider and the FB tends to migrate distally into a main bronchus. - **Left main bronchus (20–30%):** Less common due to the more horizontal angle and smaller diameter. **High-Yield:** In any child with unilateral hyperinflation on CXR + history of choking, assume right main bronchus FB until proven otherwise. Rigid bronchoscopy is the gold standard for diagnosis and removal. [cite:Robbins & Cotran 10e Ch 15]
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