Multiple foreign body aspiration.

To cite: Goussard P, Morrison JL, Nadine Appel I, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2017219248 DESCRIPTION A baby girl aged 3 years 8 months presented 8 months earlier with a history of cough and tight chest for 3 days prior to admission. On chest examination, the child had bilateral wheezing, was mildly distressed and had reduced air entry on the right side over the middle and lower zone. Chest X-ray demonstrated a round object in the oesophagus, but also collapse of the right middle and lower lobes (figure 1A). A metal washer was removed from the oesophagus at the cricopharyngeal level with a rigid scope. The child was then admitted postoperatively to paediatric intensive care unit for aspiration pneumonia. Considerable oesophageal mucosal inflammation was present at the site of the foreign body with no associated perforation. Contrast study performed at that stage demonstrated some narrowing of the oesophagus which did not need dilatation (figure 1B). Eight months later, she presented with respiratory distress and clinically reduced air entry over the right middle and lower lobe with dullness to percussion and bronchial breathing. Acute pneumonia of the right middle and lower lobe with volume loss was diagnosed (figure 1C). Ultrasound scan confirmed consolidation but no effusion present. There was no response to amoxicillin clavulanate antibiotic and bronchoscopy was performed after a week’s treatment. Pus was visible in the trachea and the right main bronchus. Significant granulation tissue was observed in the bronchus intermedius. A fragment of chicken bone was removed from the right main bronchus with a rigid bronchoscope (figure 2A). Oral corticosteroids were given for 5 days in order to reduce the amount of inflammation present in the airway. The child needed ventilation for 24 hours and was then successfully extubated. Repeat bronchoscopy was performed after 5 days due to a significant granulation tissue observed at the first bronchoscopy.