engleski

Foreign Body Aspiration in a 13-month old boy – necessity of radiographic screening

Introduction Foreign body aspiration as one of the leading cause of airway compromise in children remains a serious public health issue. It is estimated that about 3, 500 children in the U.S. die each year from foreign body suffocation. Such incidents occur in 60 to as many as 90% of cases in patients younger than 3 years, more often in male children due to their playfulness and increased curiosity. Detailed medical history, careful clinical status and radiographic examination of the thoracic organs in two directions is cruical for diagnosis, although X- ray is in many cases completely normal. Rigid bronchoscopy is the first choice for making final diagnosis and foreign body extraction. Most foreign bodies can be found in the right main bronchus (30-60%), left main bronchus (25-50%), trachea (1-13%), larynx 3%, but epidemiological data significantly depend on the authors and institution policy. Foreign body in the respiratory system can cause many complications such as pneumonia, atelectasis, emphysema and bronchiectasis. Case Report K.K., 13-month boy with inconspicuous perinatal history was hospitalized for RSV positive bronchiolitis when he was 3 months old, and due to impetigo when he was 7 months old. Until the incident he had no other medical issues. At the age of 13 months, he supposedly ‘choked’ with a dried piece of orange after which an intense cough was noted ; the father stated that he became cyanotic, so he vigorously slapped him on the back. The child was initially brought for an examination to the ER of Children’s Hospital Zagreb, from where he was reffered to the ER of ENT and Head and Neck Surgery Department for additional opinion and subsequently hospitalized with the aim of further observation. When being brought for a pediatric examination he weighed 12 kg, with no signs of cyanosis and dyspnea, having oxygen saturation of 96%, neat auscultatory finding on the lungs and no asymmetry during percussion. Radiographic imaging revealed shadow measuring 5.5 cm in length in the projection of the lower part of the trachea and intermediate bronchus (shadow of the hairpin). At that time parents discovered that the child was playing with hairpins that were lying on the floor. Foreign body was successfully removed during rigid bronchoscopy. After the procedure, the child was transferred to the Children’s Hospital Zagreb for further care and treatment near the Pediatric Intensive Care Unit. In conclusion, he was discharged without short-term and long-term complications. Conclusion Aim of this case report is to point out the importance of radiographic imaging during the diagnostic work-up of a patient with suspected foreing body aspiration having neat auscultatory and percussion findings. Prompt intervention and interdisciplinary collaboration are crucial for rapid foreign body extraction, in order to reduce the risk of late complications.

foreign body ; aspiration ; children

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