Surgical Emphysema and Pneumomediastinum after foreign body inhalation – A rare case report

Introduction:

Airway foreign bodies continue to pose a diagnostic and therapeutic challenge for otolaryngologists. Most airway foreign body aspirations occur in patients below 15 years of age and 80 – 90% in children below five years of age. Vegetable matter especially peanuts and beetle nuts are the commonest bronchial foreign bodies. The usual presenting symptoms are choking, gagging followed by wheezing and respiratory distress. This is a report of a case of bronchial foreign body with an unusual feature of subcutaneous emphysema and pneumomediastinum.

Method:

A twelve year old male child presented in an emergency room with complaints of mild respiratory distress, cough and change in voice of 48 hours duration. He was diagnosed as a case of pneumothorax (left) with subcutaneous surgical emphysema. Computed tomography (CT) scan of thorax was done which showed diffuse emphysema.

Results:

Emergency bronchoscopy under general anaesthesia (GA) using rigid bronchoscope revealed pieces of beetle nut in left main bronchus which were removed.

Conclusion:

Foreign body that obstructs the bronchus completely, leads to collapse of the distal lobe producing a stop valve effect, the foreign body which obstructs only on expiration causes a check valve type of effect which results in lobar emphysema and those causing obstruction both during both inspiration and expiration, produce bypass valve effect which present with features of bronchitis. Pleural rupture due to mediastinal emphysema may have resulted in pneumothorax. Computed tomography (CT) plays an important role in localisation of the foreign body and it's management.

Publication History

Publication Date:
18 April 2018 (online)