A Case Report on Cyanotic Spell: Suspected Foreign Body

Abstract

Tracheobronchial Foreign Body Aspiration (FBA) remains a significant cause of morbidity and mortality in children less than three years of age. High index of suspicion leads to early diagnosis and treatment thus preventing further deleterious complications. This case report is about a 15-month-old female child who presented with intermittent low-grade fever, cough, cold for 20 days and rapid breathing since one day. On examination, she had pallor, grade 3 protein energy malnutrition according to Indian Academy of Paediatrics classification, heart rate was 128/min, respiratory rate was 44/min, oxygen saturation was 88% on room air with nasal flaring, intercostal and subcostal retractions. Bilateral rhonchi with reduced air entry was present in all areas of the lung. Bilateral bronchopneumonia was seen on chest X-ray and tuberculosis work up was negative. Child was started on oxygen, antibiotics, nebulisations and intravenous fluids. On day two of admission child developed rigorous bouts of cough associated with hypoxia, bradycardia, cyanosis and listlessness which improved on bag and mask ventilation. Following a strong suspicion of obstruction in the tracheobronchial tree, a Computed Tomography (CT) neck and chest was done which was suggestive of either an intratracheal or intrabronchial foreign body. Child was urgently taken up for rigid bronchoscopy and a ground nut was found in the right main bronchus. The FBA as a differential diagnosis of chronic cough in children should always be ruled out.