Inhalation and ingestion of magnetic foreign bodies in a toddler with persistent cough—a case report

Abstract

: Inhalation and ingestion of foreign bodies are common emergency presentations in paediatric otolaryngology. Here we present a case of an incidental finding of simultaneous ingestion and inhalation of small magnets in a 21-month-old following a history of worsening cough. The initial diagnosis was thought to be a viral upper respiratory tract infection, however, due to the persistence of symptoms, a chest x-ray was obtained, which revealed two foreign bodies in the location of the left main bronchus. The first attempt at endoscopic removal of foreign bodies using laryngoscopy, bronchoscopy and oesophagoscopy (LBO) was unsuccessful due to a complete occlusion of the left main bronchus by a significant mass of friable granulation tissue precluding visualisation of the foreign bodies. An urgent computed tomography (CT) scan was obtained to further delineate the location of the foreign bodies; this, unfortunately, was limited by streak artefacts but raised the possibility of the foreign bodies being in both the airway and the oesophagus. Given the potential of a fistula and the close proximity of the objects to the carina, median sternotomy with cardiopulmonary bypass was planned for retrieval and reconstruction if endoscopic retrieval failed. Repeat endoscopy successfully retrieved two magnetic ball-bearings measuring 6mm in diameter each. One was located in the left main bronchus and the other in the oesophagus. To our knowledge, this is the first case in Australia described of two foreign bodies entering the airway and digestive tract at the same time. We discuss the presentation, diagnosis and management of this case including the diagnostic dilemma encountered and the involvement of multidisciplinary teams. This case highlights the importance of having a high clinical suspicion of foreign body inhalation/ingestion in paediatric patients presenting with prolonged unexplained respiratory symptoms and no resolution with standard treatment.