Bronchial Foreign Body Mimicking Chronic Cough and Recurrent Bronchopneumonia: Diagnostic Dilemma in a Resource Poor Setting Diagnostic Dilemma in A Resource Poor Setting

Abstract

A foreign body (FB) in the lower airway could pose a life-threatening emergency. Occasionally, small objects in the airway may present insidiously. A high index of suspicion is required to avoid a delayed or missed diagnosis of a foreign body and its attendant complications. A six-year-old male was admitted through the Children's Emergency Room (CHER) with a 6-month history of recurrent cough and fever associated with choking spells and noisy breathing, and a day's history of shortness of breath. The child was said to have “swallowed” a plastic object in the course of the illness, which the caregivers and attending physicians assumed had been passed out in faeces. He was managed as a case of recurrent bronchopneumonia with oral and parenteral medications, with temporary relief of symptoms. A chest x-ray done at presentation showed evidence of left lung collapse with an ipsilateral mediastinal shift. He had a diagnostic rigid bronchoscopy, and a plastic object was discovered within the left main bronchus and subsequently retrieved. Broad spectrum antibiotics, anti-inflammatory drugs, and antipyretics were administered, and by the second day post-op, all chest symptoms had resolved, and a repeat chest x-ray showed normal findings. We recommend that any child with a history of recurrent cough and shortness of breath that is unresponsive to medical treatment qualifies for an otolaryngological review to rule out bronchial FB via diagnostic bronchoscopy. A chest radiograph may help support the diagnosis but should not be used alone to exclude it.