Allergy and Airway |

Recurrent Pneumonia and Hemoptysis in a Four Year-Old Male With a Retained Airway Foreign Body FREE TO VIEW

Nicholas Friedman, DO; John Horton, MD; Donald Moffitt, MD; Mark Boseley, MD; Jason Caboot, MD
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Madigan Army Medical Center, Tacoma, WA

Chest. 2013;144(4_MeetingAbstracts):52A. doi:10.1378/chest.1702457
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SESSION TITLE: Airway Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Recurrent pneumonia is uncommon in children and typically associated with prematurity, congenital respiratory tract abnormalities, and cardiovascular or neurological diseases. We present the case of a child with recurrent pneumonia and hemoptysis, secondary to a retained airway foreign body, who required a pulmonary resection.

CASE PRESENTATION: EB is a 4-year-old male, with a 2 year history of chronic cough, who presented with a 2-day history of fever, cough, and hemoptysis. He was treated for 6 episodes of right lower lobe (RLL) pneumonia in the previous 2 years. Chest radiograph showed a RLL opacity and intravenous antibiotics were initiated. Chest computed tomography (CT) with contrast showed a nonspecific RLL consolidation with fluid and debris filled airways. Based on history and imaging results, flexible bronchoscopy with bronchoalveolar lavage (BAL) was performed. Flexible bronchoscopy revealed normal bronchial anatomy, but the orifice of the RLL bronchus was edematous, inflamed, and obstructed by granulation tissue. Distal to the obstruction, the visualized RLL airways had minimal secretions, but were dilated and appeared necrotic. BAL culture grew pan-sensitive non-mucoid Pseudomonas aeruginosa and EB was treated with a prolonged course of intravenous antibiotics. Following the antibiotics, repeat chest CT showed persistent RLL consolidation, atelectasis, and bronchiectasis (Figure 1). Repeat flexible bronchoscopy revealed a foreign body embedded in the granulation tissue at the orifice of the RLL. Rigid bronchoscopy could not remove the foreign body. Based on imaging and bronchoscopy findings, the RLL did not appear salvageable; therefore, lung resection was pursued, since surgery offered the opportunity to remove the foreign body and excise the diseased lung. The resected tissue was grossly abnormal with marked airway consolidation, fibrosis, and chronic inflammation (Figure 2). EB tolerated the procedure well with improved aeration of the right lung, and was discharged home on post-operative day five.

DISCUSSION: While most children with FBA fully recover, a retained airway foreign body may lead to serious pulmonary complications, secondary to the resulting inflammation. Recurrent pneumonia, atelectasis, and bronchiectasis are common complications of the prolonged presence of an airway foreign body. Surgery is occasionally required for patients with long-standing pulmonary sequelae.

CONCLUSIONS: Recurrent localized pneumonia in children should raise suspicion for a retained foreign body. Retained airway foreign bodies can lead to long term complications and recurrent pneumonia in children should be investigated with chest CT and flexible bronchoscopy.

Reference #1: Karakoc F, Karadag B, Akbenlioglu C, et al. Foreign body aspiration: what is the outcome?. Pediatr Pulmonol. 2002;34(1):30-6.

DISCLOSURE: The following authors have nothing to disclose: Nicholas Friedman, John Horton, Donald Moffitt, Mark Boseley, Jason Caboot

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