Case:
A 12-year-old girl presented with 3 year history of cough andpurulent
expectoration, responding partially to inhaled bronchodilators. There
was no seasonal or diurnal variation, wheezing, chest pain, hemoptysis
or cyanosis. There were intermittent undocumented fever episodesoverthe
past twoyears. There was decreased exertional capacity over the past 6
months. There was no history of change in appetite, ear or nasal
symptoms, aggravating or relieving factors, vomiting, epigastric
discomfort, severe multi-systemic infections, or malabsorption. There
was no contact with active tuberculosis. Examination revealed normal
vital signs and oxygen saturation in room air. Weight, height, body
massindex of 41kg, 156cm and 16.85 respectively were normal for age and
height. There was pandigital clubbing but no pallor, cyanosis, or
lymphadenopathy. Respiratory system examination revealed coarse
cracklesin right infra-scapular area with increased vocal resonance and
fremitus. Chest roentgenogram (Figure 1A) and Contrast enhanced computer
tomography (CECT)(Figure 1B, 1D) showedright lower lobe volume loss with
cystic bronchiectasis and foreign body in right lower lobe bronchus.
Review of history revealed an episode of inhaling a plastic whistle
about 5 years back. The child did not tell her parents and hence no
attempt was made to remove it.
Flexible bronchoscopy revealed a foreign body in the right lower lobe
bronchus with purulent secretions and granulation tissue. Rigid
bronchoscopy (7.5 french sheath, 43 cm length) done under general
anesthesia confirmedtheforeign body but it could not be removed despite
multiple attempts using optical forceps (5.5mm with length 50 cm) as the
object was out of reach of the forceps. A second attempt was made after
administering oral prednisolone for 48 hours. Still, the foreign body
could not be removed after multiple attempts using.
Therefore aflexible bronchoscope (Olympus BF-Q190, outer diameter 4.9
mm) as inserted through the rigid scope size (7.5 french sheath, 43 cm
length). After placing the flexible bronchoscope tip just above the
foreign body, rat-toothed forceps was inserted through the suction
channel of the flexible scope. The foreign body was grasped with
rat-toothed forceps and pulled into the rigid scope. The rigid scope
along with the flexible scope and the foreign body inside was removed
(Figure 1C) and child reintubated.The post-operative period was
uneventful and the child was discharged after three days with advice to
continue chest physiotherapy to drain the right lower lobe. During
follow-up over 8 months,thechild had markedly improved. There were no
episodes of cough or fever or exercise intolerance. She had gained 12 kg
weight (from 41kg).