An incidental finding of a
vegetative foreign body in left main bronchus in a child presented as
wheeze associated respiratory tract infection
Balaji.M.D1,
Venkatamurthy M.2, Naresh S.3
1Dr. Balaji. M.D. Professor, 2Dr. Venkatamurthy. M., Professor, 3Dr. S.
Naresh, Resident, all authors are affiliated with department of
Pediatrics, Adichunchanagiri Institute of Medical Sciences, B.G. Nagar
-571448 Karnataka, India
Address for
Correspondence: Dr. S. Naresh, Email:
nareshrajambbs@gmail.com
Abstract
Foreign body aspiration is an important cause of pediatric morbidity
and mortality, particularly in children between the age of 6 months and
five years. It is potentially life threatening event and may also cause
chronic lung injury, if not properly managed. Foreign bodies may cause
chronic pulmonary infections, bronchiectasis and lung abscess. An early
diagnosis and management of the patient with an inhaled foreign body
offers a diagnostic challenge to the treating pediatrician .We report a
case of incidental foreign body in a 3year old child presented with
recurrent episodes of wheeze associated respiratory tract infections.
Wheeze was associated with persistent cough and dyspnea with nocturnal
awakening.
Key words:
Foreign body, Rigid bronchoscopy, peanuts
Manuscript received: 2nd
June 2017, Reviewed:
12th June 2017
Author Corrected:
21st June 2017, Accepted
for Publication: 28th June 2017
Introduction
Foreign body aspiration in children is most common especially those
below the age of 3 years [1]. Foreign body causes significant airway
occlusion it may lead to asphyxia and it is unfortunately a leading
cause of death in childhood [2]. However, aspiration of foreign body
more often presents with a history of an initial episode of choking and
coughing with subsequent respiratory symptoms [1,3]. These include
cough, wheeze, stridor, or pneumonia. The most common lung sign is
decreased breath sounds or abnormal breath sounds [1,4]. In children
food items are the most commonly inhaled foreign bodies and peanuts
being the most common [4].
Case
Report
A 3 year old boy bought with complaints of cough since 3 weeks with
occasional noisy breathing at nights, with no other complaints. There
is no history suggestive of choking, shortness of breath. On
examination there is bilateral air entry with markedly reduced breath
sounds on left side of chest with hyper resonance on percussion, and
X-ray revealed emphysematous lung with hyper inflated lung fields on
left side. Patient was hospitalized and advised for computed tomography
of chest which revealed “abrupt cut off of left main bronchus
with emphysematous changes involving whole left lung parenchyma causing
mediastinal shift to the right”. On further evaluation, was
advised for bronchoscopy by an otolaryngiologist expert in paediatric
bronchoscopy.
After pre-operative work up patient taken up for bronchoscopy under
general anesthesia and vegetative foreign body (pea nut of 0.8*0.6cm)
was retrieved and procedure was uneventful. Patient recovered well in
post-operative stay and stabilized with supportive care.
Fig 1: Abrupt
cut off of left main bronchus with emphysematous changes involving
whole left lung parenchyma causing mediastinal shift to the right
Fig 2: X-RAY
showing left emphysematous lung with hyper inflated lung fields
Fig 3: 2
weeks after post retrieval of foreign body showing normal lung fields
Fig 4:
Retrieved pea nut from left bronchus
Discussion
The majority of Foreign body aspiration occur in children younger than
3 years of age and boys being most common among them [5,6]. The
tendency to introduce objects into the mouth, smaller diameter of their
airway, activity while eating, immature dentition and having older
siblings (who may place food or objects into the mouths of infants or
toddlers) are the most common predisposing factors for Foreign body
aspiration in children [1,7]. In older children, anatomic abnormalities
and neurologic disorders predispose to Foreign body aspiration [8].
Food items such as peanuts, seeds, nuts, popcorn, beans, and corn are
the most common item aspirated by infants and toddlers. Nonfood items
such as coins, balloons, paper clips, pins, toy parts, needles, and pen
caps more commonly are aspirated by older children [9]. Most of the
objects aspirated by children are radiolucent, whereas only 18% to 20%
of aspirated foreign bodies are radiopaque in nature [7,9].
Younger children especially under 3 years, have considerable risk of
foreign body aspiration as they have tendency of using their mouth to
explore their surroundings and at this stage of development, the main
objects aspirated are vegetable seeds, peanuts and toy parts. The type
of the foreign body also depends on social, cultural and economic
status and eating habits of the family [9,10,11].
Foreign body aspiration can be easily diagnosed with a typical history
of aspiration (such as acute onset of choking and coughing) and
atelectasis or hyperlucency on chest radiography. Unusual and
misleading cases especially without aspiration history present with
asthma like symptoms such as wheeze, chronic cough and recurrent or
persistent pulmonary infiltrations, bronchiectasis and atelectasis
[10,11,12] his is an example of misleading case, without aspiration
history, presented with chronic cough and noisy breathing at night.
Decreased air entry and hyper resonance on percussion is the
predominant physical findings in our study.
Conclusion
The clinical presentation of unwitnessed foreign body aspiration may be
subtle, and diagnosis requires careful review of the history, clinical
assessment. Hence, children who presents with prolonged respiratory
symptoms, especially at the age of 1-3 require a high index of
suspicion, and should consider foreign body aspiration as one of the
differential diagnosis.
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
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How to cite this article?
Balaji. M. D, Venkatamurthy M, Naresh S. An incidental finding of a
vegetative foreign body in left main bronchus in a child presented as
wheeze associated respiratory tract infection. J
PediatrRes.2017;4(06):357-360.doi:10. 17511/ijpr.2017.06.01.