Question

Presentation and management of foreign body right bronchus in a 3-year-old child.

Hint:

Foreign body aspiration in children often presents with sudden onset of wheezing or coughing. Early recognition and prompt bronchoscopy are crucial for successful management.

Answer 1

Presentation of Foreign Body in the Right Bronchus: Foreign body aspiration in children is a common emergency, and the right bronchus is more commonly affected due to its more vertical and wide structure compared to the left. In a 3-year-old child, the presentation typically includes:
1. History:
- Sudden onset of coughing, choking, or gagging during or after eating or playing with small objects is common.
- Stridor and wheezing may develop, especially if the foreign body is lodged in the bronchus.
- A history of aspiration or playing with small objects like nuts, coins, or toys is essential for diagnosis.
2. Clinical Features:
- Unilateral wheezing: The child may present with persistent wheezing on one side of the chest due to airway obstruction.
- Cough: Persistent or paroxysmal cough that doesn't resolve with typical treatment for respiratory infections.
- Dyspnea: Difficulty breathing, increased respiratory rate, and signs of respiratory distress.
- Tachypnea: Increased breathing rate in the absence of other causes.
- Cyanosis: In severe cases, there may be signs of hypoxia, such as bluish discoloration of lips and extremities.
3. Investigations:
- Chest X-ray: This is the first-line imaging study to look for radiopaque foreign bodies. However, in some cases, the foreign body may be radiolucent (e.g., plastic, food), and a lateral view or CT scan may be needed for better visualization.
- Bronchoscopy: The gold standard for diagnosis and treatment. It allows direct visualization and removal of the foreign body.
Management of Foreign Body in the Right Bronchus:
1. Initial Management:
- Airway management: Ensuring the child’s airway is clear is the priority. In cases of respiratory distress or hypoxia, oxygen should be administered immediately.
- Positioning: If the child is conscious, back blows and chest thrusts can be performed to dislodge the foreign body.
2. Bronchoscopy:
- Rigid bronchoscopy under general anesthesia is the most effective method for removing the foreign body from the bronchus. Rigid bronchoscopy is preferred in children due to better control of the airway and removal of foreign bodies.
- Flexible bronchoscopy may be used in some cases to visualize and remove smaller objects, but it is less effective in managing large or hard foreign bodies.
3. Post-procedural Care:
- After the foreign body is removed, the child is monitored for any complications such as airway swelling, infection, or pneumothorax.
- Antibiotics may be given if there is a concern for infection, especially if the foreign body has been lodged for a prolonged period.
- Follow-up chest X-rays are done to ensure there is no residual foreign body or complications.