Laryngeal Foreign Body Aspiration in Infancy: A Diagnostic Challenge

Abstract

Foreign body aspiration (FBA) is a significant cause of accidental death among children, with laryngeal FBA being relatively rare but potentially fatal due to airway obstruction. This report highlights a case of laryngeal FBA in an 11-month-old child, initially misdiagnosed as viral croup. Otolaryngological evaluation, particularly in the case of laryngeal FBA, may facilitate management. An 11-month-old male was brought to the emergency department, presenting with inspiratory stridor following a choking episode. A chest radiograph and CT scan of the chest were read as normal. He was suspected of having croup and treated with dexamethasone and racemic nebulized epinephrine, which led to temporary clinical improvement. The child returned with persistent stridor to the emergency department eight days after his initial visit, prompting an otolaryngological consultation. Flexible laryngoscopy ultimately identified a star-shaped sequin lodged in the glottis. The foreign body was successfully removed via direct laryngoscopy and bronchoscopy (DLB). Following the removal, the patient demonstrated significant improvement and eventually made a full recovery. This case emphasizes the difficulty in diagnosing laryngeal FBA due to its non-specific symptoms and the limitations of imaging techniques. The importance of a thorough clinical history, physical examination, and proper imaging combined with a high index of suspicion is crucial for early diagnosis and treatment. Additionally, the report discusses the potential for severe complications if diagnosis and treatment are delayed, highlighting the need for awareness and prompt intervention in suspected laryngeal FBA cases.

Keywords: direct laryngoscopy and bronchoscopy; flexible laryngoscopy; glottic foreign body; laryngeal foreign body aspiration; pediatric foreign body removal.

Figure 1. Computed tomography images of the chest

A) Chest CT sagittal view demonstrating a thin foreign body in the glottis (arrow), consistent with a thin plastic sequin star B) CT neck axial view further demonstrating a thin plastic foreign body in the glottis.

Figure 2. View of the glottis during direct laryngoscopy

Granulation tissue (arrow) and edema are seen in the larynx immediately following FB removal.

Figure 3. Foreign body retrieved: sequin star approximately 1.2 cm in diameter