Acute chest pain in a 14 year old following chronic foreign body inhalation: a case report

Foreign body inhalation is a common, life-threatening emergency that may present acutely or remain undiagnosed for years. While it typically occurs in young children, delayed presentation in older children is also possible, particularly when the initial event goes unwitnessed.

We present the case of a 14-year-old male of Hausa ethnicity, who developed acute right-sided chest pain, superimposed on a 4-year history of mild chronic cough. Notably, he had remained asymptomatic for 1 year following the initial foreign body inhalation event. He had a history of inhaling and aspirating a button battery at age nine, for which no diagnostic workup was conducted at that time. On current presentation, an urgent chest radiograph revealed a disc-shaped metallic foreign body in the right bronchial tree with associated middle and lower lobe collapse. A "double ring" halo sign on the X-ray indicated the object was a button battery. Chest Computed tomography (CT) confirmed the battery's location in the right bronchus intermedius with surrounding fibrosis and multiple segmental lobar collapses. Bronchoscopic removal was attempted but failed due to occlusion of the bronchus by cicatrization and fibrosis. The patient subsequently underwent a right thoracotomy and bronchotomy to retrieve the battery. Postoperatively, the collapsed lung segments re-expanded, and his symptoms resolved.

This case illustrates that an inhaled foreign body can remain undetected for years, leading to chronic pulmonary changes. Inhaled button battery requires a high index of suspicion and urgent imaging-even in delayed presentations. Early diagnosis, prompt imaging and timely intervention are essential to prevent chronic complications and the need for invasive surgical procedures.