Despite the negative previous bronchoscopy, a different surgeon is called for bronchoscopy under general anesthesia. Initial laryngoscopic exam reveals an erythematous and mildly edematous epiglottis. The remainder of the procedure is then performed via bronchoscopy, which reveals an erythematous trachea with an injected mucosa. There is also moderate edema in both mainstem bronchi, and marked edema in the subsegmental bronchi on the right side. The lower lobe bronchus contains granulation tissue that is friable, and upon retracting the granulation tissue, a foreign body is visualized and removed.
Histologic exam reveals vegetable matter consistent with a nut.
Most commonly, patients may present with localized wheezing, diminished air movement, and rhonchi on auscultation of the lungs. However, these findings may not always be present and certainly may seem diffuse over both lung fields due to transmission of those sounds through the bronchi. Foreign body aspiration should always be considered in a child with unexplained pulmonary problems. Even if all radiographic studies are negative, clinical suspicion should lead one to consider bronchoscopy since negative radiographic studies are not able to totally rule out foreign bodies. The treatment of choice is bronchoscopy for removal of the foreign body.