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Delayed diagnosis of foreign body aspiration in children
T Hilliard1, R Sim, M Saunders
1Department of Respiratory Medicine, Royal Hospital for Children, Bristol, UK. tom.hilliard@ubht.swest.nhs.uk
Insights
Foreign body aspiration in children often causes respiratory symptoms after choking. Early bronchoscopy is recommended for suspected cases to avoid diagnostic delays.
Area of Science:
- Pediatrics
- Pulmonology
- Emergency Medicine
Background:
- Foreign body aspiration is a frequent pediatric emergency.
- Initial choking episodes may be followed by respiratory distress, mimicking other conditions.
- Diagnostic challenges arise due to varied presentations and limitations of imaging.
Observation:
- Three pediatric cases with delayed foreign body aspiration diagnosis (days to weeks) are presented.
- Delayed diagnosis was attributed to insufficient historical review and suboptimal investigation use.
- Symptoms included cough, wheeze, stridor, and diminished breath sounds.
Findings:
- Radiological imaging can aid diagnosis but is insufficient for exclusion.
- A high index of suspicion is crucial for timely identification.
- Bronchoscopy is the definitive diagnostic and therapeutic tool.
Implications:
- Emphasizes the need for careful patient history taking in suspected aspiration.
- Highlights the importance of appropriate diagnostic workup, including bronchoscopy.
- Suggests that prompt referral for bronchoscopy can prevent prolonged illness and complications.
Abstract:
Foreign body aspiration in children is common and usually presents with an initial episode of choking with subsequent respiratory symptoms. There may be cough, wheeze, or stridor, with decreased or abnormal breath sounds on examination. However, it can mimic other illnesses and cause difficulty in diagnosis. Radiological investigations may help to confirm aspiration but should not be used to exclude it. Three cases are presented of foreign body aspiration with a delay in diagnosis ranging from days to weeks. It is believed that delay could have been avoided with a more careful approach to the history and more appropriate use of investigations. These cases demonstrate that children with a history of choking and subsequent symptoms should be referred for bronchoscopy.