A one-year-old boy with persisting coughing spells and stridor was seen at the Tokai University Hospital and was found to have a shift of the trachea on chest x-ray. The parents denied an episode of aspiration of foreign body. After being afebrile and asymptomatic for 14 days with an improvement in chest x-ray, the patient developed high fever, aggravating coughing spells and stridor, and the patient was referred for bronchoscopic evaluation.
The evening before the day of bronchoscopy, the patient suddenly developed severe dyspnea and emergency resuscitation was sustained. Immediate chest x-ray study showed pneumothorax of the right lung and atelectasis of the left lung. Constant aspiration of air from the right pleural cavity followed by the insertion of a catheter resulted in no improvement.
Emergency bronchoscopy was performed under general endotracheal anesthesia, and a small plastic piece, apparently a pair of toy wheels on an axle was found at the entrance of the left main bronchus and was removed. The patient's respiration was remarkably improved immediately after the removal of the foreign body. Reexpansion of the right lung was observed on the following day of the operation and the intrapleural catheter was removed.
The etiological considerations were as follows: one inferable cause would be that a foreign body initially lodged in the entrance of the right main bronchus with inspiratory check-valve action caused hyperinflation of the right lung followed by spontaneous pneumothorax, and then the foreign body moved to the left main bronchus producing a complete obstruction of the airpassage and atelectasis of the left lung. Another inferable cause would be that the foreignbody lodged and stayed in the left main bronchus throughout the entire clinical course and produced atelectasis. Increased reipiratory effort and hyperventilation in the right lung caused rupture of bleb or bulla of the right visceral pleura to result in pneumothorax.
