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Endobronchial Foreign Body Presenting as Exacerbation of Asthma
James E Tsang1, June Sun2, Gaik C Ooi3
1Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Insights
Airway foreign bodies are a significant cause of childhood mortality. Early recognition is crucial, as delayed diagnosis can complicate treatment, as seen in a child with asthma-like symptoms due to a Lego aspiration.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Emergency Medicine
Background:
- Airway foreign bodies (AFBs) represent a critical pediatric emergency, often presenting with acute respiratory distress.
- Delayed diagnosis of AFBs can lead to prolonged symptoms and complications, mimicking other respiratory conditions.
- Prompt medical recognition is essential for effective management and prevention of mortality.
Observation:
- A 7-year-old boy presented with a week of worsening respiratory distress, initially presumed to be asthma.
- Initial chest X-ray was unremarkable, delaying the diagnosis of a foreign body.
- A low-dose computed tomography (CT) scan revealed a foreign body in the left main bronchus.
Findings:
- Aspirated Lego toy identified as the foreign body in the left main bronchus.
- Successful removal of the foreign body was achieved via fiberoptic bronchoscopy.
- The patient's presentation mimicked asthma, highlighting diagnostic challenges.
Implications:
- This case underscores the importance of considering AFBs in children with unexplained or persistent respiratory symptoms, even with normal initial imaging.
- Low-dose CT is a valuable tool for diagnosing AFBs when conventional radiography is inconclusive.
- Early and accurate diagnosis of AFBs is vital to prevent severe respiratory compromise and mortality in children.
Abstract:
Airway foreign bodies are a leading cause of death among children and require urgent recognition by medical personnel. While most cases are diagnosed readily from a clinical history of acute respiratory distress, some cases remain more indolent and present later. We report the case of a 7-year-old boy who aspirated a "LEGO" toy and presented with a week history of increasing respiratory distress compatible with known asthma. Despite a normal chest X-ray, a low-dose computed tomography showed the presence of a foreign body in the left main bronchus, which was subsequently removed by fiberoptic bronchoscopy. Our case serves to reemphasize the importance of considering airway foreign bodies as a cause of respiratory distress, especially in young children.
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