Respiratory · Year 1 · from Respiratory
Case 2: Foreign Body Aspiration
Clinical Image
Source: Wikimedia Commons - Bronchoscopy - CC BY-SA 3.0
Case Presentation
A 3-year-old boy is brought to the emergency department by his parents after a witnessed choking episode while eating peanuts approximately 4 hours ago. He initially coughed vigorously but then seemed to improve. However, his parents noticed he has developed persistent coughing and wheezing, particularly on the right side. On examination, he is alert but appears mildly distressed. Vital signs show heart rate 118 bpm, respiratory rate 28/min, and oxygen saturation 95% on room air. Auscultation reveals decreased breath sounds and expiratory wheezing over the right lung, with normal breath sounds on the left. Chest X-ray shows hyperinflation of the right lung with mediastinal shift to the left on expiration, consistent with air trapping from a ball-valve mechanism. Given the clinical history and imaging findings, flexible bronchoscopy is performed, revealing a peanut fragment lodged in the right main bronchus. This is successfully removed with grasping forceps, and the child recovers well. The anatomical predisposition for foreign bodies to enter the right main bronchus is explained by its shorter length, wider diameter, and more vertical orientation compared to the left main bronchus.
Key Learning Points
- The right main bronchus is shorter, wider, and more vertical than the left main bronchus, making it the more common destination for aspirated foreign bodies
- The trachea bifurcates at the carina (approximately T4-5 level) into the right and left main bronchi
- Foreign body aspiration can cause a ball-valve effect with air trapping and hyperinflation of the affected lung
- Understanding bronchopulmonary segment anatomy is essential for localizing and managing aspirated materials