The mother insisted it was a peanut

Abstract

Introduction: Foreign body (FB) aspiration is an accident which is more common in pre-school children, and may lead to serious disease or even death.The most common clinical presentations of FB aspiration are choking crisis, cough, wheezing, fever and X-ray abnormalities. There may also be no clinical or radiological signs, thus making anamnesis the key element for diagnosis. Case Report: Following a choking crisis while playing with peanuts, a twenty month-old toddler begins coughing and wheezing, and was immediately brought to the local emergency department. Since the chest radiography was normal, she was discharged with a presumptive non-confirmed suspicion of FB aspiration and received a prescription of bronchodilators. Since the symptoms persisted, she went to see her family physician three more times (in the last two she was again referred to the hospital emergency department).After this third visit and 33 days after the choking crisis, she underwent bronchoscopy,which revealed a bronchial FB (a peanut shell) with associated bronchial wall necrosis. Comment: This case report illustrates that anamnesis is considerably superior to chest radiography in the diagnosis of suspected FB aspiration. Furthermore, it stresses that complications may arise if the diagnosis is delayed, and highlights the benefits of both multidisciplinary care and anticipatory guidance on child health surveillance plans.