A laryngeal foreign body misdiagnosed as asthma bronchiale

A Foreign Body Lodged in the Glottis of a Toddler for a Prolonged Time: Anatomical Considerations and Review of the Literature

Our scope is to present the unusual case of an impacted foreign body in a child's larynx for a prolonged period due to recurrent misdiagnosis and review the literature emphasizing the laryngeal foreign body. A toddler girl from a rural region was initially referred to a primary pediatric care center due to a sudden choking episode. The mother made an unsuccessful attempt to pull out a possible foreign body by blind finger sweeping. After 22 days of recurrent misdiagnosis and unsuccessful conservative therapies, the child developed hoarseness of voice and dyspnea during physical exertion. The patient underwent a flexible nasopharyngolaryngeal endoscopy, which observed a foreign body in the glottis, and an emergency microlaryngoscopy. Persistence of laryngeal symptoms in a child with a sudden choking episode should always raise the suspicion of a respiratory tract foreign body impaction. The most appropriate therapeutical approach is rigid bronchoscopy under general anesthesia.

Misdiagnosed Tooth Aspiration in a Young Handicapped Boy: Case Report and Recommendations

Tooth inhalation remains a rare incident but it may occur during dental care, especially in children. We report here the case of a four-year-old boy with Down syndrome who came to the hospital after a dental trauma. During the extraction procedure, he aspired his maxillary incisor without presenting any signs of respiratory distress and was discharged by the surgical team, who thought that he had swallowed the tooth. Three weeks later, he was admitted to the emergency service because of a pulmonary infection. Two endoscopy interventions under general anesthesia were necessary to recover the foreign body inside the left lung. Because of the multiple symptoms associated with the trisomy 21 syndrome (general hypotonia, impaired immunity, etc.), practitioners should be very mindful of aspiration risks and complications during dental care. The systematic prescription of lung radiography would prevent the onset of pulmonary infections and enable an earlier intervention.

Thin laryngeal foreign bodies in infants: diagnostic potential of MDCT

A laryngeal foreign body (FB) is a significant, life-threatening event in the paediatric population. Incomplete airways obstruction by a thin, laminar, radiolucent FB lodged in the glottis or supraglottis is a rare occurrence that may present with non-specific symptoms, absence of chest findings, and normal radiographic investigations, resulting in misdiagnosis, delay in diagnosis, or prolonged recovery. We report two cases of 10-month-old male infants, each with a thin radiolucent FB lodged between the vocal folds that was detected with low-dose multidetector computed tomography (MDCT) and thin-slice reconstruction. Both infants presented with symptoms of respiratory airway inflammation at clinical examination and negative neck and chest radiographs. FBs were removed by direct laryngoscopy, without complications. In our experience, low-dose MDCT with thin-slice reconstruction is particularly useful for diagnosis in cases of suspected FB aspiration with uncertain clinical presentation and negative radiographic exams.

Lessons Learned From 35 Cases of Laryngeal Foreign Bodies Undergoing Misdiagnosis in Pediatric Population

OBJECTIVES

To present 35 cases of laryngeal foreign bodies (FBs) in pediatric population undergoing misdiagnosis so as to draw on our lessons to improve early diagnosis.

METHODS

A retrospective analysis over 15 years was conducted of 35 cases of laryngeal FBs undergoing misdiagnosis in children. Meanwhile, a control group, including 42 cases of laryngeal FBs without misdiagnosis in children, was set. These patients' clinical data were collected and analyzed to identify the risk factors for misdiagnosis.

RESULTS

The results of chi-square test and univariate analysis both showed a significant difference in time elapsed between discomforts and admission, witnessed foreign body (FB) aspiration history, biphasic stridor, aphonia, roentgenologic findings, and type and size of FBs between the misdiagnosed group and control group. Multivariate analysis further identified delayed doctor visits, unwitnessed FB aspiration history, nonspecific symptoms, and negative roentgenologic manifestations as independent risk factors for misdiagnosis.

CONCLUSIONS

Diagnosis of laryngeal FBs, especially small, thin, and radiolucent FBs, remains a challenge. We emphasized the importance of timely doctor visits, careful clinical history inquisition, and prompt performance of radiographic or endoscopic examinations for diagnosis.

A foreign body of the larynx misdiagnosed as vocal cord paralysis

Foreign bodies in the aerodigestive tract continue to be a common problem that contribute significantly to high morbidity and mortality all over the world. Laryngeal foreign bodies may present with less severe symptoms compared with lower respiratory tract foreign bodies, resulting in misdiagnosis, confusion and delay in diagnosis. Rigid endoscopy with forceps removal under general anaesthesia is the preferred management modality. This case is described to show the importance of a detailed history and examination including X-ray neck in children to rule out any radiopaque laryngeal foreign body as a delay in diagnosis and management can lead to life-threatening complications.

A rare case of coin impaction in larynx in an adult

Impaction of foreign body in larynx is reported exclusively in paediatric population only. Moreover impaction of coin in larynx has never been reported previously. With this background, we report a rare case of coin impaction in larynx in a healthy adult.

[Diagnosis and treatment guidelines for difficult-to-control asthma in children]

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.