Charu Tiwari
All India Institute of Medical Sciences, India
Title: Whistle aspiration in bronchus: Two cases
Biography
Biography: Charu Tiwari
Abstract
Abstract
Background: Accidental tracheobronchial foreign body aspiration is relatively common in children; especially in 1 – year age group. Vegetative or organic foreign bodies like ground nuts and peanuts account for about 75% of aspirated vegetable foreign bodies. We present two cases of whistle aspiration into the bronchus.
Case Summary:
Case 1: An eight-year-old boy was referred to Pediatric Emergency with diagnosis of foreign body in left main bronchus. History revealed that the boy had aspirated the whistle while playing with it one week back, followed by cough, fever and respiratory symptoms. HRCT thorax suggested foreign body in left bronchus with hyperinflation on ipsilateral side. At admission, he was afebrile, tachypneic, air entry was absent on left side. Sp02 was 96 % with 2 liters of oxygen. Bronchoscopy was done with 4.5 Fr rigid ventilating bronchoscope and a large foreign body was identified in left main bronchus. It was removed with help of Optical forceps. As the whistle has 3 different parts to make it; it was not possible to remove in assembled form. It was removed in 3 parts. Check bronchoscopy confirmed completeness of procedure. The post-operative recovery was uneventful.
Case 2: A seven-year boy was admitted with history of aspiration of whistle while playing 3 days back. At admission, his vitals were stable; and air entry was reduced on right side. Chest x-ray and HRCT thorax confirmed the foreign body in right main bronchus. The whistle was identified in the right main bronchus and all three parts removed by rigid bronchoscopy with 4.5 Fr ventilating bronchoscope. Check bronchoscopy ensured completeness. Post-operative recovery was uneventful.
Discussion and Conclusion: In pediatric patients, the usual history and classical symptoms of aspiration are mostly absent. Clinical examination suggesting absent or reduced unilateral respiratory sounds and tachypnoea point towards foreign body aspiration. An X-ray chest would suggest ipsilateral hyperinflation or collapse consolidation. An HRCT thorax in such patients helps in detection and localization of foreign body. The management is rigid bronchoscopy and removal of the foreign body. Whistle may be aspirated in slightly older kids while playing with it, as was the case in both our cases. The whistle is unique because it is made of three parts (one of which is transparent) assembled together. During bronchoscopic removal, care must be taken to remove all the three parts of the whistle separately; secondly, complete removal should be ensured by check bronchoscopy after removal.