Delayed diagnosis of radiopaque tracheal foreign body in a child

Abstract

9-year-old girl was brought to the Emergency Departent by her mother on the advice of a school nurse who eard “wheezing.” The patient reported being examined hat same morning at school by the nurse after a peakow meter “did not register” while there only to “drop ff her asthma medications.” The patient began having hortness of breath 4 to 6 weeks before this visit. She was tarted on an albuterol inhaler at that time. There was no rior history of asthma or wheezing. The difficulty reathing would wax and wane but was worse at night ith coughing. Several visits to the child’s doctor had ollowed. A course of antibiotics was completed and she as using inhaler medications as prescribed. Sputum, rouble swallowing, and fevers were denied. The patient ointed to her sternal notch and said it felt as if “somehing was stuck there.” Further questioning revealed that approximately 1 to 2 eeks before the onset of initial symptoms, the patient ad a plastic bowtie (from a doll) in her mouth and had choking episode lasting the whole first night and then ubsequently subsiding. Only thereafter did she develop er current respiratory symptoms. On physical examination, the patient was afebrile ith normal vital signs including pulse oximetry. She as alert with a normal voice and no accessory respira-