Pediatric Airway Foreign Body
Patient Presentation:
A 2-year-old male, E.R., presented to the emergency department after a weeklong history of chronic coughing. Parents noted that E.R., a previously healthy toddler, had worsening cough throughout the week with “noisy breathing” which led them to the emergency department. Upon assessment, vital signs were heart rate of 126 bpm, axillary temperature of 36.7°C, blood pressure of 94/52, respiratory rate of 32, and an SpO2 of 97% on room air. E.R. had no visible chest retractions, nasal flaring, cyanosis or dyspnea. Upon auscultation, E.R. had generalized wheezing with diminished breath sounds on the right side and a persistent non-productive cough.
Differential Diagnosis:
Asthma, pneumonia, and pediatric airway foreign body
Diagnosis:
In the emergency department, E.R. was given a nebulized albuterol treatment with no improvement in symptoms. A chest x-ray was obtained with no abnormal findings. Because of the physical exam and E.R.’s presentation, a foreign body aspiration was highly suspected. Parents were then questioned further about the onset of the symptoms and did eventually recall an episode in the week prior where the five-year old sibling was helping to feed E.R. when the acute coughing began. Parents did not initially recall this episode, which is often the case with pediatric airway foreign body diagnosis.
Treatment:
E.R. was admitted to the pediatric medical/surgical unit and underwent general anesthesia to have a rigid bronchoscopy. A rigid bronchoscopy is the best technique used for visualization of the inside of the airway and identification with subsequent removal of the foreign body object. With E.R., the object removed was a piece of stringed cheese. The object had been lodged in the right main stem bronchus. This object would not have shown up on radiographic studies because it is radiolucent. No medications were needed in this case because no significant airway swelling or infection was observed during the bronchoscopy.
Outcome:
After the procedure, E.R. was kept overnight for observation and was able to be released in stable condition with no requirement for follow up care.