Author(s)
Rebecca A Compton1
Andrew R Scott2
Affiliation(s)
1Tufts Medical Center; MA;2Floating Hospital for Children at Tufts Medical Center; MA
Abstract:
Objective: To review an unusual case of aerodigestive foreign body and its implications for endoscopic management.Method: Case report.Results: We report a case of a 2-year-old boy who presented after an episode of sudden coughing during unwitnessed play at home. He was initially diagnosed with seasonal allergies at an outside hospital and treated with Claritin. He returned to our institution one week later with persistent cough and wheezing. On examination, he had decreased breath sounds on the right. Chest x-ray demonstrated right upper lobe pneumonia and lateral decubitus film showed air trapping in the right lung consistent with bronchial obstruction. We proceeded with microdirect laryngoscopy and bronchoscopy, revealing a bright red, waxy substance occluding the right primary bronchus. When an attempt was made to extract the object with optical peanut forceps, it crumbled and required retrieval in piecemeal fashion. Upon removal, a strawberry-flavored odor emanated from the airways. There was granulation tissue lining the proximal bronchus and purulent secretions in the right upper lobe bronchus requiring suction clearance with a pediatric feeding catheter. The patient subsequently made a full recovery. Playdough was our best guess as to the nature of the foreign body, but the mystery was solved when the mother discovered an empty tube of strawberry-flavored red lipstick among her child’s toys.Conclusion: This case illustrates the potential aspiration risk among toddlers for non-edible objects that are nevertheless flavored and brightly colored. We also show potential respiratory and inflammatory sequelae of delayed diagnosis of airway foreign bodies.