ry 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

_Roentgenography_.--All cases of chest disease should have the benefit
of a roentgenologic study to exclude bronchial foreign body as an
etiological factor. Negative opinions should never be based upon any
plates except the best that the wonderful modern development of the
art and science of roentgenology can produce. In doubtful cases, the
negative opinion should not be conclusive until a roentgenologist of
long experience in chest work, and especially in foreign body cases,
has been called in consultation. Even then there will be an occasional
case calling for diagnostic bronchoscopy. Antero-posterior and lateral
roentgenograms should always be made. In an antero-posterior film a
flat foreign body lying in the lateral body plane might be invisible
in the shadow of the spine, heart, and great vessels; but would be
revealed in the lateral view because of the greater edgewise density
of the intruder and the absence of other confusing shadows.
Fluoroscopic examination will often discover the best angle from which
to make a plate; but foreign bodies casting a very faint shadow on a
plate may be totally invisible on the fluoroscopic screen. The value
of a roentgenogram after the removal of a foreign body cannot be too
strongly emphasized. It is evidence of removal and will exclude the
presence of a second intruder which might have been overlooked in the
first study.

Fluoroscopic study of the swallowing function with barium mixture, or
a barium-filled capsule, will give the location of a nonroentgenopaque
object (such as bone, meat, etc.) in the esophagus. If a flat or
disc-shaped object located in the cervical region is seen to be lying
in the la