Challenges in Diagnosing Foreign Bodies in Children

Abstract

Foreign body aspiration in children is a medical emergency that is associated with significant morbidity and requires medical intervention. The variability of clinical presentations results in delayed diagnosis and treatment. Hence, a high index of clinical suspicion and a thorough examination is needed to expedite the management. We report the case of a toddler girl who aspirated a piece of peanut and was diagnosed as having bronchopneumonia upon presentation with respiratory symptoms for six days. Rigid bronchoscopy was performed and the foreign body was removed successfully without any complications. We aim to highlight the importance of considering the diagnosis of airway foreign body in children with unexplained respiratory distress in our case study.

The Mysterious Whistling Breath: Foreign Body Aspiration

“…A retrospective review done between June 2011 and June 2016 in a Malaysian tertiary academic institution revealed that older children tend to not inform their caretaker of choking episodes which leads to misdiagnosis of asthma [ 4 ]. Other misleading initial diagnoses include bronchiolitis, pneumonia, and laryngitis, as reported by Cassol et al [ 5 ]. Complications severity usually depends on the time lag from the onset of aspiration to diagnosis [ 2 ].…”

“…According to Sahadan et al, children under the age of three had the highest rate of accidental ingestion and aspiration due to their propensity for placing objects in their mouths, crying, or playing with them while doing so [ 5 ]. Due to this habit, another complication that is commonly reported is the impaled foreign body due to the aspiration of the object [ 6 ].…”

“…Despite this, a normal chest X-ray does not rule out foreign body aspiration; hence, a bronchoscopy should always be performed if there is clinical suspicion [ 3 ]. Rigid bronchoscopy has been the gold standard method of removal for an aspirated foreign body [ 5 ]. Since the right bronchus is anatomically shorter and wider than the left one, it is the location where foreign bodies are most frequently encountered [ 5 ].…”

“…Rigid bronchoscopy has been the gold standard method of removal for an aspirated foreign body [ 5 ]. Since the right bronchus is anatomically shorter and wider than the left one, it is the location where foreign bodies are most frequently encountered [ 5 ]. Early intervention of foreign body removal results in good clinical outcomes with the likelihood of resolution of the complications [ 3 ].…”

Airway Foreign Bodies in Children: A Review Article

“…The most common location of affected lung lobe is the right lower lobe because it is larger and more vertical. Bilateral lower lung lobes are usually affected by aspiration during standing while alcoholics who aspirate in a prone position may have right upper lobe infiltrated commonly [25].…”