CRP4 CANDY CHUCKED, LUNGS STUCKED

Iqmal A1, Fatin Farihah1, Tan SH2, Dayang Zuraini2, Nalini Selveindran1, Ahmad Izani MS3, Komathi Ramachandran3
Paediatric Department, Hospital Putrajaya
Pediatric Respiratory Hospital Sultan Idris Shah, Serdang
ENT Department, Hospital Putrajaya

Foreign-body aspiration is a frequent occurrence in children, sometimes presenting as a life-threatening emergency requiring immediate removal of the aspirated object. However, delays in diagnosis can occur due to atypical history, lack of parental recognition of symptoms seriousness, or oversight of clinical and radiological findings by healthcare providers.

We report a 7 years old girl who had a left lung atelectasis due to ingestion of a chocolate candy cap. She was noticed to be cyanosed by her teacher but there was no witness of aspiration. Unfortunately, this history was not highlighted and was discharged home as she was deemed well. She continued to have cough, cyanosis and revisited hospital. Examination showed a tachypnoeic child with markedly reduced breath sounds over the left lungs. Initial imaging showed left upper lobe collapse, and she was managed as pneumonia. However, she deteriorated requiring noninvasive ventilation with progressive unilateral reduced breath sounds.  Repeated Xray showed complete opacification of left lung with tracheal deviation. CT Thorax supported this. Flexible bronchoscopy showed a blue solid foreign body obscuring the left main bronchus. Following the removal of the aspirated object, patient was discharged home well. 

Foreign body aspiration was not considered in this child since she falls outside the demographic most affected, children under 3 years old, with 60% of cases occurring in the right main bronchus. Our postulation is that the localization in the left main bronchus was a consequence of the push of the ingested cap by nebulisation and ventilation. 

A delay in diagnosis was due to unwitnessed aspiration, poor history, lack of parental recognition and oversight of clinical suspicion. An atypical presentation of unilateral reduced breath sounds should raise suspicion of foreign body aspiration.