2011 OPEN FORUM Abstracts
SHIFTING ATELECTASIS: A SIGN OF FOREIGN BODY ASPIRATION (FBA) IN A CHILD.
Diana L. Mark1, Laura M. Murphy2; 1Respiratory Care, Wesley Medical Center, Wichita, KS; 2Pediatric Intensive Care Unit, Wesley Medical Center, Wichita, KS
Introduction: Foreign body aspiration (FBA) is a serious, often life-threatening condition. In infants and children there are several conditions that could mimic an aspirated foreign body such as asthma, croup, pneumonia, and bronchiolitis. Case Summary: An eighteen month old was admitted to PICU intubated, after presenting in the emergency department with a productive cough, tachypnea, tachycardia, and perioral cyanosis. The patient presented during peak RSV season. A rapid RSV screen was performed and reported as negative. Arterial blood gas prior to intubation revealed PH- 6.96, PCO2- 101, PO2- 272, and HCO3- 22.4. Parents report the cough began a few weeks ago and recently became productive. This progressed to frequent "coughing spells" and respiratory distress. There is no history of asthma. Initial chest X-ray revealed complete opacification of the right hemithorax with medistinal shift. Persistent wheezing was noted with diminished breath sounds on the right. Continuous albuterol, chest physiotherapy, lung recruitment, and positioning were initiated. Day 4, overall improvement of the right lung atelectasis had occurred. Ventilator settings, albuterol, and chest physiotherapy were weaned. On Day 6, frequent desaturations, into the 50's, occurred. Increases in FIO2, PEEP, and manual bagging failed to improve saturations. Breath sounds indicated wheezes on the right with diminished lung sounds on the left. Chest x-ray revealed near-complete opacification and extensive atelectasis of the left lung with medinastinal shift. Immediate fiberoptic bronchoscopy was performed at bedside revealing a foreign body. The patient was emergently transferred to the OR for foreign body extraction. A pinto bean was removed from the patient's left mainstem bronchus. Postoperative breath sounds were equal. Chest x-ray showed marked improvement of the left lung with minimal right atelectasis. Extubation occurred on Day 8 with subsequent dismissal on Day 11. Discussion: Our patient had persistent symptoms and signs compatible with respiratory tract infection and asthma but was not responsive to medical treatment. Therefore, further workup is warranted which included the bronchoscopy to evaluate the cause of respiratory symptoms. FBA should be considered when a patient exhibits unexplained symptoms consistent with airway obstruction, shifting atelectasis, and refractory medical treatment. Sponsored Research - None