Importance of patient history in diagnosis of foreign body aspiration in children: Two case reports

RATIONALE: Accidental tracheobronchial foreign body aspiration (FBA) is one of the diseases with the highest morbidity and mortality in early childhood. A history of aspiration is very important for diagnosis, as sometimes there are no abnormalities in the physical examination of the patient. Parental negligence and inappropriate treatment may be important reasons for the delay in diagnosis. We describe 2 cases of misdiagnosed children with an unclear history of aspiration. PATIENT CONCERNS: A 5-year-old boy, who fell out of bed when sucking pistachios and landed on his neck, was initially diagnosed as a closed injury of the larynx. An 18-month-old girl, who developed a cough and difficulty breathing after she fell to the ground surrounded by many corn grains. DIAGNOSIS: Bronchoscopy examination confirmed the diagnosis of tracheobronchial foreign bodies. INTERVENTIONS: The foreign bodies were removed by bronchoscopy examination. OUTCOMES: Both patients were discharged after removal of the foreign bodies and antibiotic treatment. LESSONS: Aspiration history is crucial for the correct diagnosis of FBA, and lack of history may lead to the misdiagnosis of FBA. Parents should be educated to increase their awareness of tracheobronchial FBA, and avoid providing their children with small objects that can potentially block the airways. When FBA is suspected, the child should be sent to a hospital immediately. Diagnostic rigid bronchoscopy is recommended.