Unusual Presentation of Foreign Body Aspiration as Pleural Effusion in an Infant

Abstract

To the Editor: Foreign body aspiration presenting as isolated pleural effusion without an underlying pneumonia is rare. So far only one case has been reported [1].An 11-mo-old boy presented with a history of sudden onset of fast breathing and retractions since last 4 h. He was hemodynamically stable with 95 % saturation under hood oxygen. Auscultation revealed decreased air entry on the left side. Chest radiography showed pleural effusion with collapse lung on left side with ipsilateral mediastinal shift. Ultrasound chest showed left sided pleural fluid of 6 mm depth. Diagnostic pleural tap showed a transudative fluid with no pus cells or bacteria. Total blood WBC count was 18,600 with 78 % polymorphs. The child had a fever spike of 101°F 2 h after admission. Hence, a possibility of community acquired pneumonia with synpneumonic effusion was kept and child was started on intravenous ceftriaxone.After 48 h of treatment, the child's respiratory distress did not improve and air entry was persistently decreased on the left. Blood culture and pleural aspirate culture were sterile, no further fever spikes. Repeat chest radiography showed a partially expanded lung with only minimal blunting of costophrenic angle on the left and hyperinflated lung on the right. Hence, on clinical grounds, a diagnostic fibreoptic bronchoscopy was done which revealed a Bengal gram piece in the left intermediate bronchus. Urgent rigid bronchoscopy was done and two pieces of Bengal gram were removed from the left intermediate bronchus. Post procedure the child was treated with intravenous steroids and adrenaline nebulisation. The child showed dramatic improvement, respiratory distress settled. Repeat chest radiography 12 h later was normal. Blood counts normalised to a total count of 10,600 with 63 % polymorphs and the child was discharged after 48 h.

Isolated Pleural Effusion- An Interesting Case Report of Foreign Body Aspiration-A Case Report

“…7 In another case, an 11 month old boy presented with an acute onset of respiratory distress due to pleural effusion following aspiration of a piece of Bengal gram. 8 Both cases presented with acute onset respiratory distress. Inflammatory reaction to the FB in the tracheobronchial tract could be the main reason for this pleural effusion, though the exact process is uncertain.…”

Pleural effusion as a rare presentation of foreign body aspiration

“…On the other hand, there are a few reports of pleural effusion due to FBA as the chief presentation, with only three adults cases [ [7] , [8] , [9] ] and two pediatric cases [ 10 , 11 ] being reported. One case [ 9 ] was of empyema, and the cultures in four cases [ 7 , 8 , 10 , 11 ] were sterile. However, antibiotics were administered before thoracentesis in three of the latter foure cases, which had similarities with the present case.…”