P130 Severe bronchopulmonary suppuration following late diagnosis of foreign body aspiration – paediatric case report

Introduction Foreign body aspiration is a common occurrence in children, especially among those younger than 3 years of age and is a potentially life-threatening event. Chronic debilitating symptoms with recurrent infections might happen with delayed diagnosis. Case report A 1 year 7 months old boy was admitted with a 2 month history of recurrent episodes of productive cough and high fever, progressive worsening despite empirical antibiotic therapy, with severe dyspnea, intense coughing and perioral cyanosis. His symptoms have followed a choking episode while eating sunflower seeds, ignored by the parents. Physical examination revealed a well-nourished child, in moderate respiratory distress, tachypnea, persistent productive cough, dullness to percussion and abolished breath sounds of inferior half of the left lung field and crackles, bronchial breathing in the upper half. Oxygen saturation and other systemic examination were normal. Laboratory investigation showed leukocytosis, neutrophilia, severe inflammatory syndrome, and the chest x-ray with completely opaque left hemithorax. We presumed the diagnosis of bronchial foreign body aspiration and started medical treatment with complex systemic antibiotic, antimycotic, bronchodilator and anti-inflammatory agents. Rigid bronchoscopy revealed significant stenosis of the left main bronchus, possible granuloma, mucosal oedema, bronchiectasis with thick secretions and a vegetable foreign body which was removed. During the examination, a large quantity of foetid mucopurulent liquid was drained. Other two successive bronchoscopies were necessary for bronchoalveolar lavage. Bronchial aspirate culture was positive for Acinetobacter baumanii. Thoracic CT confirmed significant stenosis and complete atelectasis of the left lung, with air leakage areas included. The medical treatment was continued and the patient was discharged with clinical and laboratory improvement of his condition. Though, chronic bronchial obstruction with bronchiectasis and destruction of lung parenchyma requires surgical care. Pneumectomy versus inserting a bronchial stent are yet to be discussed. Conclusion Delayed diagnosis of foreign body aspiration may associate serious complications, particularly for vegetable matter, being responsible for intense inflammatory response and bronchopulmonary suppurations. Careful anamnesis is required to identify those needing additional investigation for early diagnosis.