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Management of an unusual presentation of foreign body aspiration
H H Ramadan1, N Bu-Saba, A Baraka
1Department of Otolaryngology, American University of Beirut, Lebanon.
Insights
Foreign body aspiration in children is a serious risk. A rare case of isolated pneumomediastinum without pneumothorax after chickpea aspiration was successfully managed with bronchoscopy.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Thoracic Surgery
Background:
- Foreign body aspiration is a frequent and potentially fatal event in young children.
- Management can be challenging, particularly with rare radiological findings.
Observation:
- A 2-year-old asthmatic boy aspirated a chickpea, presenting with subcutaneous emphysema and isolated pneumomediastinum on chest X-ray.
- This specific presentation of pneumomediastinum without pneumothorax is infrequently reported in pediatric literature.
Findings:
- Bronchoscopic removal of the foreign body was successfully performed using apneic diffusion oxygenation and intermittent positive pressure ventilation.
- The patient experienced immediate improvement in subcutaneous emphysema and pneumomediastinum post-procedure.
Implications:
- This case highlights successful management strategies for rare foreign body aspiration complications in children.
- It underscores the importance of prompt diagnosis and tailored interventions for pediatric airway emergencies.
Abstract:
Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.