A Case of Pediatric Bronchial Foreign Body Treated Nine Years After Presentation

Abstract

Introduction: Missed or delayed diagnosis can happen in cases of pediatric bronchial foreign body with mild, unspecific and infrequent symptoms such as cough and stridor. We report a case of pediatric bronchial foreign body treated nine years after the onset of symptoms. Case: A 10-year-old boy was referred to us because of a bronchial polyp. He had a history of aspiration when he was eating fish at the age of one and suffered from continuous wheezing, which was diagnosed as being due to asthma. Larynx fiber inspection revealed no abnormality at the age of two and the symptoms improved spontaneously within two years. He started to suffer from recurrent pneumonia and was diagnosed as having bronchiectasis when he was seven years old. Bronchofiberscopy was performed at the age of nine, which demonstrated a bronchial polyp in the right bronchus. Although pneumonectomy was planned, he was referred to us to consider the possibility of bronchoscopic resection of the polyp. Chest computed tomography showed a high-density area at the distal side of the polyp, which was identified as a foreign body. A dark green mass behind the polypoid lesion in the truncus intermedius was excised under bronchoscopy. Histopathological analysis revealed a fish bone and a reactive polyp. His postoperative course was uneventful and his symptoms improved. However, bronchiectasis still remains in the right lower lobe and he suffers from pneumonia annually. Conclusion: Meticulous history taking and a high index of suspicion are crucial for the diagnosis and treatment of bronchial foreign body. In cases in which a bronchial foreign body cannot be ruled out, chest computed tomography should be considered.