Imaging-based diagnosis of cryptic foreign body aspiration in a toddler with normal clinical presentation: A case report

Foreign body aspiration is a potentially life-threatening emergency in children in the immediate or long-term setting. Classical clinical signs may be absent, leading to missed or delayed diagnosis. We report the case of a one-year-old female who aspirated a metallic pin that lodged in the left postero-basal segment. She was clinically asymptomatic throughout the course of management with diagnosis secured through imaging prompted predominantly by persistent maternal concern. Impacted foreign body removal was done via thoracotomy in the completely asymptomatic child after 35 days. This case underscores the importance of very vital but frequently under-emphasized aspects of the diagnosis and management of cases of pediatric foreign body aspiration; early imaging, especially in early presentation even in the absence of classical signs; the possible diagnostic challenges posed by radiolucent objects; the distinct anatomical considerations of the pediatric tracheobronchial tree and; the rare need for thoracotomy when endoscopic retrieval is not feasible.