Retained Bronchial foreign bodies: Is there a role for high‐resolution computed tomography scan?

The diagnosis and treatment of bronchial foreign bodies have been well discussed in the literature, and the principles of management were outlined by Jackson and Jackson in 1936.1 Accurate diagnosis in the pediatric population occasionally continues to pose a dilemma despite heightened awareness and improved medical technology.111 Some patients will have retained foreign bodies after bronchoscopy, with the reported incidence ranging from 1% to 18°~.3'5'12 A constellation of chronic airway symptoms then develop that precipitate various noninvasive and invasive diagnostic strategies.We present a case of a retained bronchial foreign body and discuss the diagnostic utility of the high-resolution pulmonary computed tomography (CT) scan. CASE REPORTAn 8-month-old boy had an episode of paroxysmal coughing while playing outdoors in the grass and was taken to the emergency department for a suspected foreign body aspiration.Physical examination then was normal, and the child was discharged.No chest x rays were obtained.During the next 4 weeks, the patient had a chronic cough, wheezing, and two episodes of right lower lobe pneumonia.The treating pediatrician suspected a foreign body aspiration, and the patient was referred to a pediatric surgeon.Six weeks after the initial event, the patient underwent rigid bronchoscopy, and some pine needles were removed from the right medial basilar seg-From the Otolaryngology-Head and Neck Surgery Service, Brooke Army Medical Center.The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Departments of the Army or Defense.