Bronchial foreign body mimicking chronic cough and recurrent bronchopneumonia: Diagnostic dilemma in a resource poor setting

Abstract

Foreign body (FB) in the lower airway could pose a life-threatening emergency. Occasionally, small objects in the airway may present insidiously. High index of suspicion is required to avoid delayed or missed diagnosis of foreign body with its attendant complications. A Six-year-old male admitted through the Children Emergency Room (CHER) with 6 months history of recurrent cough and fever associated with choking spells and noisy breathing, and a day history of shortness of breath. Child was said to have “swallowed” a plastic object in the course of the illness, which the care givers 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. Chest x-ray done at presentation showed evidence of left lung collapse with 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 and antipyretics were administered and by the second day post-op, all chest symptoms had resolved, and 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 otolaryngological review to rule out bronchial FB via diagnostic bronchoscopy; Chest Radiograph may help support diagnosis but should not be used alone to exclude it.