Kothari Harsh, Jawahar Aravinth Prasanth, Badheka Aditya, Chegondi Madhuradhar
Pediatric Critical Care Medicine, Dayton Children's Hospital, Dayton, USA.
Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, USA.
Cureus. 2023 Dec 10;15(12):e50283. doi: 10.7759/cureus.50283. eCollection 2023 Dec.
Chronic cough can be a diagnostic challenge in the pediatric population. Foreign body aspiration without typical signs and symptoms can often be overlooked as a cause of chronic cough in children. Coin aspirations in the trachea typically have a sagittal orientation on an anteroposterior (AP) chest radiograph. We report a rare case of a previously healthy five-year-old girl presenting with a chronic cough for five months caused by a coin with a coronal orientation on an AP chest radiograph. The coin, initially presumed to be lodged in the esophagus, was actually lodged in the cervical trachea, leading to the development of a tracheoesophageal fistula (TEF). Her AP chest radiograph showed a coronal, circular radio-opaque shadow and the lateral view a tangential radio-opaque shadow, prompting an initial evaluation by esophagogastroduodenoscopy, which was normal. She then underwent rigid bronchoscopy, revealing a coin lodged in the trachea along with a TEF. Surgical removal was achieved through an external approach with a vertical tracheotomy and insertion of a tracheostomy tube. Five days later, a repeat rigid bronchoscopy showed a well-healed TEF, and she was successfully decannulated. She was ultimately discharged home on room air and oral feeds. TEF as a complication of a foreign body lodged in the trachea or esophagus is rare but life-threatening. Foreign body aspiration should always be considered in the differential diagnosis when evaluating younger children with chronic cough.
慢性咳嗽在儿科人群中可能是一个诊断难题。没有典型体征和症状的异物吸入常常会被忽视，而成为儿童慢性咳嗽的一个病因。气管内的硬币吸入在前后位（AP）胸部X线片上通常呈矢状位。我们报告一例罕见病例，一名此前健康的5岁女孩因一枚在AP胸部X线片上呈冠状位的硬币导致慢性咳嗽5个月。这枚硬币最初被推测嵌顿在食管内，实际上嵌顿在颈段气管，导致了气管食管瘘（TEF）的形成。她的AP胸部X线片显示一个冠状位的圆形不透X线阴影，侧位片显示一个切线状不透X线阴影，这促使最初进行了食管胃十二指肠镜检查，结果正常。随后她接受了硬质支气管镜检查，发现一枚硬币嵌顿在气管内，同时伴有气管食管瘘。通过外部途径进行垂直气管切开并插入气管造口管实现了手术取出。5天后，再次进行硬质支气管镜检查显示气管食管瘘愈合良好，她成功拔管。她最终在家中出院，可正常呼吸并经口进食。气管食管瘘作为气管或食管异物的一种并发症很罕见，但危及生命。在评估患有慢性咳嗽的年幼儿童时，鉴别诊断中应始终考虑异物吸入。
