A 3 Year Old Boy With Sudden Choking While Playing With His Toys

A 3 year old boy is brought to the emergency department when he was seen to have a sudden choking while he was normal and playing with his toys. He has no history of any respiratory infection.

The Chest X ray is shown below:

What is the most probable diagnosis?

Inhaled foreign body

Case Discussion:

Airway foreign bodies in children are potentially fatal and proper recognition is important because delayed diagnosis is common and may lead to death of the child if not treated immediately. 

It is most commonly seen in children under the age of 4 years.

Clinical Features:

• History of witnessing the choking event

•  Cough

• Difficulty Breathing

Aspirated foreign bodies have a predominance for the right tracheobronchial tree'

Radiographic features

Plain film

• chest x-ray will be normal in ~35% (range 30-40%) of patients 
• unilateral emphysema or atelectasis are the most common findings; only uncommonly will a radio-opaque foreign body be demonstrated

CT

• can be useful in assessment of missed or retained foreign body after initial bronchoscopy

Treatment:

Bronchoscopy is considered to be the gold standard in the diagnosis of the foreigh body with the added benefit of being able to remove the foreign body during the procedure. 

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