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.