A Case of Bronchial Foreign Body (Peanut) with Mediastinal Herniation of the Lung

Abstract

Radiolucent foreign body inhalation in infants is sometimes very difficult to diagnose without an eye-witness. Infrequently, some families will not grant permission to operate because they desire positive proof of foreign body aspiration. In the present paper a case of bronchial peanut foreign body complicated with mediastinal herniation of the lung is described. The patient was a 22 month old boy. He presented to us because of continuation of a hyper radiolucent area with a reduction in breathing sounds in the left lung. His parents denied the possibility of foreign body aspiration. Chest radiography demonstrated air trapping in the left lung and mediastinal deviation to the right. An inhaled foreign body in the left bronchus was strongly suspected. The family was asked to permit bronchoscopy under general anesthesia to confirm and remove the foreign body. However, since the boy was very lively in outward appearance and had no symptoms, they desired convincing evidence of foreign body aspiration. Although the chest CT revealed a narrowing of the left bronchus, MRI demonstrated no intraluminal object in this site. Four days after diagnosis, the chest radiography showed remarkable mediastinal herniation of the lung. Since remarkable mediastinal herniation which happens rapidly is sometimes followed by collapse of the cardiovascular and respiratory system, the parents were advised that this state was a sign of pressing danger.
Removal was undertaken by means of ventilation bronchoscopy under general anesthesia the following morning. One half of a peanut was removed. Intraoperative and postoperative courses were uneventful. Following surgery, the mediastinal herniation disappeared and the breathing sounds were normal.