Dr. Venumadhav, Dr. Sajith Keshavan, Dr. C.Jayakumar
A two-year-old male attended a local hospital with a history of choking after consuming peanuts. Initial management at the primary care facility involved a CT Virtual Bronchoscopy, which revealed a 6x6mm soft density lesion in the airway, subsequently it was removed through bronchoscopy. Despite initial treatment, the child’s condition worsened, marked persistent wheeze and desaturations, leading to readmission in an intubated state to AIMS
At admission child had , bilateral wheeze . Labs showed mildly elevated inflammatory markers indicative of an ongoing inflammatory process. The treatment initiated included intravenous steroids and broad-spectrum Antibiotics.
Differential Diagnosis
Residual foreign body
Viral Lower Respiratory Tract Infection , Allergic Reaction,
Gastroesophageal Reflux Disease (GERD).
Pneumonia
pictures showing foreign body in the medial basal segment of lowerlobe, which were retrieved using rigid bronchoscopy
Diagnostic Interventions
Further diagnostic efforts included chest X-rays and respiratory viral panel, yielding normal findings. In view of persistent symptoms,repeat bronchoscopy deemed necessary. Due to the limitations of flexible bronchoscopy in young children for therapeutic purposes, rigid bronchoscopy was done, which revealed mucopurulent lesions throughout the airway and identified three small pieces of peanut in the medial basal segment of the right lower lobe and the left lower lobe.
Treatment and Outcome
The fragments’ fragility, partly dissolved bronchial secretions, posed a significant retrieval challenge. The innovative use of a Fogarty balloon catheter proved instrumental in safely extracting these pieces. Post-operative management included chest physiotherapy and nasal prong oxygen, allowing for successful extubation two days later.
Discussion
This case highlights the complexities of diagnosing and managing pediatric foreign body aspiration (FBA), where initial removal of a visible object did not alleviate symptoms, pointing to the potential for multiple aspirated items or residual fragments. The utilization of rigid bronchoscopy was crucial for a definitive diagnosis and effective treatment, demonstrating its superiority over flexible bronchoscopy in such pediatric cases. Additionally, the innovative use of the Fogarty balloon for retrieving fragile foreign bodies showcases the evolving landscape of techniques available for pediatric FBA management.
Carry Home Message
Residual foreign body obstruction must always be considered as a differential in children presenting with recurrent and persistent wheeze, even after an initial foreign body has been removed
