Presentation
Chocking while eating almonds, then coughed on 2 occasions very briefly. Noted noise in the chest . On examination no shortness of breath , no tachypnea, no drooling, no issue with swallowing, active and alert , well perfused.
Patient Data
On examination in the emergency department diminished air entry on right side on auscultation. Chest X rays are performed and the following findings are noted.
Front chest and Right lateral decubitus view shows increased transradience and paucity of bronchovascualr markings in the right mid zone and lower zones on the frontal view with failure of physiological expiratory collapse of the right lung suggesting air trapping. Decubitus view show failure of proportionate expiratory collapse/shift of mediastinum in right lung when compared to left side.
Conclusion: When correlating with the history, appearances are concerning of radiolucent aspirated foreign body on the right side.
Case Discussion
Posted for urgent rigid bronchoscopy.
On bronchoscopy examination, the left main steam bronchus was clear and the right main bronchus had a distal obstruction of a foreign body with clear secretions. Foreign body retrieved was an almond. After suctioning and removal of almond, there was evidence of mucosal granulation, which was apparently friable but without bleed.
Improved air entry on auscultation and symmetrical chest raise after retrieval of the foreign body.