Keywords
Foreign body, pediatric emergency medicine, pulmonary disease, children
To the editor
Case 1
A 1-month and 2-year-old presented to our hospital with a history of
cough and discomfort 1 day after eating peanuts. At that time, the
patient was accompanied by severe cough, and the family members did not
perform a professional backslap to alleviate the symptoms. No obvious
suffocation was observed, and the purple lips of the patient did not
affect food intake. However, the patient continued to cry and had heavy
breathing sounds, which could not be relieved. Therefore, they sought
medical attention at our hospital. Chest computed tomography (CT) and
coronal minimum intensity projection (MinIP) revealed an abnormal
density shadow on the right side of the trachea above the tracheal
protrusion, a foreign body in the trachea, and emphysema in the upper
lobe of the right lung (Fig. A-1). A three-dimensional image rendering
bronchial image revealed local bronchial interruption (Fig. A-2).
Routine blood tests were normal.
Subsequently, emergency bronchoscopic surgery was performed to remove
foreign bodies from the trachea. Then, after the induction of general
anesthesia, a rigid 4.5-mm bronchoscope was introduced into the mouth. A
laryngoscope was used to lift the glottis, revealing a peanut-like
foreign body below the glottis and above the protrusion. The foreign
body was removed, and the left and right main bronchi were explored. The
lumen was unobstructed, and no obvious secretion was observed. After
surgery, the patient returned to the surgical intensive care unit.
Postoperative CT reexamination and three-dimensional imaging revealed
that the foreign body had disappeared. The child’s condition was good.
Case 2
An 8-month-29-day-old boy with a history of cough a day after feeding
chestnuts presented to our hospital. At that time, the child experienced
shortness of breath, accompanied by obvious coughing and a bluish
complexion, and presented with breathing difficulties. The family
members did not perform professional backslap to alleviate the symptoms,
while the patient was showing signs of breathing and wheezing.
Therefore, they came to our hospital for treatment today. Chest computed
tomography and coronal MinIP revealed a high-density shadow (arrow) in
the right main bronchus, with emphysema in the right lung (Fig. B-1). A
three-dimensional image rendering bronchial image revealed local
bronchial interruption (Fig. B-2). The child’s condition was good, and
routine blood test results were normal.
Subsequently, emergency bronchoscopic surgery was performed to remove
foreign bodies from the trachea. Then, after the induction of general
anesthesia, a rigid 4.0-mm bronchoscope was introduced into the mouth.
During the operation, foreign bodies were found at the opening of the
right main bronchus with secretion retention. After the secretion was
aspirated, the foreign bodies were removed using foreign body forceps. A
broken chestnut was found. No obvious foreign bodies remained in the
airway. After the operation, the patient returned to the ward.
Postoperative CT reexamination revealed that the foreign bodies had
disappeared. The child’s condition was good.
Case 3
A 2-month-old boy with a history of cough and crying half a day after
eating peanuts presented to our hospital. Chest CT and coronal MinIP
revealed a high-density shadow (arrow) in the left main bronchus, with
emphysema in the left lung (Fig. C-1). A three-dimensional image
rendering bronchial image revealed local bronchial interruption (Fig.
C-2). Combined with clinical history and CT results, a diagnosis was
made of a foreign body shadow in the left main bronchus, and the left
lung showed signs of excessive ventilation. Routine blood tests were
normal.
Subsequently, emergency bronchoscopic surgery was performed to remove
foreign bodies from the trachea. After the induction of general
anesthesia, a rigid 4.5-mm bronchoscope was introduced into the mouth.
After exposing the protrusions and checking the patency of the right
bronchial opening, yellow foreign bodies were found at the left main
bronchial chamber with secretion retention. After the secretions were
aspirated, the foreign bodies were removed using foreign body forceps.
After removing the foreign bodies, which were broken peanuts, no obvious
foreign body residues were observed. After the operation, the child
returned safely and his condition was good. Postoperative CT
reexamination and three-dimensional imaging revealed that the foreign
bodies had disappeared. The child’s condition was good.
Foreign body aspiration (FBA) in children is associated with serious
complications, such as bronchiectasis, atelectasis, emphysema, and
recurrent pneumonia, which may subsequently cause severe airway
obstruction, and is the fourth most common cause of accidental death in
children younger than 3 years of age1. FBA is a
medical emergency, which is an important cause of morbidity and
mortality, resulting in high morbidity rates ranging from 10% to 20%
worldwide2. The causes of FBA include increased crying
and eating actions and teeth not fully developed3.
Cough is the most common symptom and is spasmodic, dry, and irritative.
Choking sensation and cyanosis are some accompanying
manifestations4. CT has been used to identify airway
foreign bodies; bronchoscopy is the definitive test and facilitates
removal5. FBA often occurs in the main bronchus and
the left and right main bronchi. This case shows that FBA should not be
overlooked, particularly in children who develop gradual aggravation or
sudden fetal danger.