Guerra Paula V, Anderson Kelvin, Clausen Sean M, Carr Michele M
Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA.
Cureus. 2024 May 12;16(5):e60144. doi: 10.7759/cureus.60144. eCollection 2024 May.
Foreign body aspiration (FBA) is a significant cause of accidental death among children, with laryngeal FBA being relatively rare but potentially fatal due to airway obstruction. This report highlights a case of laryngeal FBA in an 11-month-old child, initially misdiagnosed as viral croup. Otolaryngological evaluation, particularly in the case of laryngeal FBA, may facilitate management. An 11-month-old male was brought to the emergency department, presenting with inspiratory stridor following a choking episode. A chest radiograph and CT scan of the chest were read as normal. He was suspected of having croup and treated with dexamethasone and racemic nebulized epinephrine, which led to temporary clinical improvement. The child returned with persistent stridor to the emergency department eight days after his initial visit, prompting an otolaryngological consultation. Flexible laryngoscopy ultimately identified a star-shaped sequin lodged in the glottis. The foreign body was successfully removed via direct laryngoscopy and bronchoscopy (DLB). Following the removal, the patient demonstrated significant improvement and eventually made a full recovery. This case emphasizes the difficulty in diagnosing laryngeal FBA due to its non-specific symptoms and the limitations of imaging techniques. The importance of a thorough clinical history, physical examination, and proper imaging combined with a high index of suspicion is crucial for early diagnosis and treatment. Additionally, the report discusses the potential for severe complications if diagnosis and treatment are delayed, highlighting the need for awareness and prompt intervention in suspected laryngeal FBA cases.
异物吸入（FBA）是儿童意外死亡的重要原因，其中喉部FBA相对少见，但因气道阻塞可能致命。本报告重点介绍了一例11个月大儿童的喉部FBA病例，该病例最初被误诊为病毒性喉炎。耳鼻喉科评估，特别是对于喉部FBA病例，可能有助于治疗。一名11个月大的男性被送往急诊科，在一次窒息发作后出现吸气性喘鸣。胸部X光片和胸部CT扫描结果均正常。他被怀疑患有喉炎，并接受了地塞米松和消旋雾化肾上腺素治疗，这导致了临床症状的暂时改善。在初次就诊八天后，该儿童因持续喘鸣返回急诊科，于是进行了耳鼻喉科会诊。灵活喉镜检查最终发现一枚星形亮片卡在声门处。通过直接喉镜和支气管镜检查（DLB）成功取出了异物。取出异物后，患者症状明显改善，最终完全康复。该病例强调了由于喉部FBA症状不具特异性以及成像技术的局限性，诊断存在困难。全面的临床病史、体格检查、适当的成像检查以及高度的怀疑指数对于早期诊断和治疗至关重要。此外，报告讨论了如果诊断和治疗延迟可能出现的严重并发症，强调了在疑似喉部FBA病例中提高认识并及时干预的必要性。
