Diagnostic challenges in paediatric foreign body aspiration: a case report
Abstract
Introduction: Foreign body aspiration (FBA) is a potentially fatal paediatric emergency. Our objective was to highlight the importance of a multidisciplinary approach to difficult/doubtful diagnosis.
Case Report: 34-month-old girl referred for urgent rigid bronchoscopy after suspected metallic blade ingestion (found chewing on it). She had a previous recurrent history of wheezing. The physical examination revealed face/lip wounds, traces of powder on her teeth but no breathing difficulty. The plain X-Ray revealed radiopaque images of the upper pulmonary field and gastric chamber. In the absence of FBA clinical signs but considering a previous history of bronchial hyperresponsiveness, a direct digital radiographic study was performed. There were no images compatible with foreign bodies: the results were interpreted as artefacts and no bronchoscopy was performed.
Conclusions: A careful pre-anaesthetic evaluation, a high level of suspicion and excellent multidisciplinary communication led to the recognition of false radiologic findings. A conservative approach was followed and invasive procedures in a remote location, with high anaesthetic risk for the paediatric population were avoided.
References
Fidkowski CW, Zheng H, Firth PG. The Anesthetic Considerations of Tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesthesia Analgesia 2010; 111(4):1016-25; DOI: http://doi.org/10.1213/ANE.0b013e3181ef3e9c
Abd-ElGawad EA, Ibrahim MA, Mubarak YS. Tracheobronchial foreign body aspiration in infants & children: Diagnostic utility of multidetector CT with emphasis on virtual bronchoscopy. The Egyptian Journal of Radiology and Nuclear Medicine 2014; 45(4):1141-1146(6); DOI: http://doi.org/10.1016/j.ejrnm.2014.07.003
Brady AP. Errors and discrepancy in radiology: inevitable or avoidable? Insights Imaging. 2017; 8(1):171–182; DOI: http://doi.org/10.1007/s13244-016-0534-1
Hitter A, Hullo E, Durand C, et al. Diagnostic value of various investigations in children with suspected foreign body aspiration: review. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):248-52; DOI: http://doi.org/10.1016/j.anorl.2010.12.011
Sink J, Kitsko D, Georg M et al. Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg. 2016 Sep;155(3):501-7. DOI: http://doi.org/10.1177/0194599816644410
E. Divarci, Toker B, Dokumcu Z et al. The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration. Int J Pediatr Otorhinolaryngol. 2017 Sep;100:232-237; DOI: http://doi.org/10.1016/j.ijporl.2017.07.012
Liew CJ, Poh AC, Tan TY. Finding nemo: imaging findings, pitfalls, and complications of ingested fish bones in the alimentary canal. Emerg Radiol. 2013;20(4):311-22; DOI: http://doi.org/10.1007/s10140-012-1101-9
Kim K, Lee H, Yang E et al. Foreign body removal by flexible bronchoscopy using retrieval basket in children. Ann Thorac Med. 2018 Apr-Jun; 13(2): 82–85. DOI: http://doi.org/10.4103/atm.ATM_337_17
Sheehan C, Lopez J, Elmaraghy C. Low rate of positive bronchoscopy for suspected foreign body aspiration in infants. Int J Pediatr Otorhinolaryngol. 2018 Jan;104:72-75; DOI: http://doi.org/10.1016/j.ijporl.2017.10.030
Soong WJ, Tsao PC, Lee YS et al. Retrieval of tracheobronchial foreign bodies by short flexible endoscopy in children. Int J Pediatr Otorhinolaryngol. 2017;95:109–13: DOI: http://doi.org/10.1016/j.ijporl.2017.01.033
Tenenbaum T, Kähler G, Janke C et al. Management of foreign body removal in children by flexible bronchoscopy. J Bronchology Interv Pulmonol. 2017;24:21–8; DOI: http://doi.org/10.1097/LBR.0000000000000319
Mansour B, Elias N. Foreign Body Aspiration in Children With Focus on the Role of Flexible Bronchoscopy: A 5 Year Experience. Isr Med Assoc J. 2015 Oct;17(10):599-603; PMID: 26665311
Londino A, Jagannathan N. Anesthesia in Diagnostic and Therapeutic Pediatric Bronchoscopy. Otolaryngol Clin North Am. 2019 Dec;52(6):1037-1048; DOI: http://doi.org/10.1016/j.otc.2019.08.005
Haller L, Barazzone-Argiroffo C, Vidal I et al. Safely Decreasing Rigid Bronchoscopies for Foreign-Body Aspiration in Children: An Algorithm for the Emergency Department. Eur J Pediatr Surg. 2018 Jun;28(3):273-278; DOI: http://doi.org/10.1055/s-0037-1603523
Safari M, Manesh M. Demographic and Clinical Findings in Children Undergoing Bronchoscopy for Foreign Body Aspiration. Ochsner J, 2016. 16(2): p.120-4; PMC4896653.
Downloads
Copyright (c) 2021 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.
