Clinician’s Corner
Case 4: ‘Spontaneous’ emphysema in a toddler A two-year-old girl was brought to the emergency department with acute swelling in the neck following a bout of cough. She had received two courses of antibiotics for suspected chest infection from her general practioner. At presentation, she was hemodynamically stable and not in respiratory distress. However, there was a swelling in the neck and right axilla with crepitus. A chest x-ray revealed subcutaneous emphysema in the region of swelling (Figure 1). In addition, there were signs of consolidation in the right lower lobe. She was admitted to hospital and treated with intravenous antibiotics for pneumonia. Overnight, she went into respiratory distress requiring emergency intubation and transfer to the intensive care unit. Further investigation led to the underlying diagnosis.
Correspondence (Case 4): Dr Pooja Siddhi, Department of Pediatrics, Heart of England NHS Trust, Brodesley Green East, Birmingham, West Midlands B9 5SS. Telephone 01245-362000, e-mail [email protected] Case 4 accepted November 4, 2015
Paediatr Child Health Vol 21 No 3 April 2016
©2016 Pulsus Group Inc. All rights reserved
139
Clinician’s Corner
Case 4 Diagnosis: foreign body aspiration
The attending anesthetic team intubated her under bronchoscopic assistance. A small, white, rounded object was found in the right main bronchus, which on removal, was found to be a peanut. Her parents retrospectively recalled an episode of sudden violent cough when they were at a birthday party two months before this presentation. She made good recovery in the intensive care unit and was extubated 72 h later. She completed a seven-day course of intravenous antibiotics and was discharged home without any complications. Foreign body (FB) aspiration accounts for approximately 7% of accidental deaths among children
Case 4: ‘Spontaneous’ emphysema in a toddler A two-year-old girl was brought to the emergency department with acute swelling in the neck following a bout of cough. She had received two courses of antibiotics for suspected chest infection from her general practioner. At presentation, she was hemodynamically stable and not in respiratory distress. However, there was a swelling in the neck and right axilla with crepitus. A chest x-ray revealed subcutaneous emphysema in the region of swelling (Figure 1). In addition, there were signs of consolidation in the right lower lobe. She was admitted to hospital and treated with intravenous antibiotics for pneumonia. Overnight, she went into respiratory distress requiring emergency intubation and transfer to the intensive care unit. Further investigation led to the underlying diagnosis.
Correspondence (Case 4): Dr Pooja Siddhi, Department of Pediatrics, Heart of England NHS Trust, Brodesley Green East, Birmingham, West Midlands B9 5SS. Telephone 01245-362000, e-mail [email protected] Case 4 accepted November 4, 2015
Paediatr Child Health Vol 21 No 3 April 2016
©2016 Pulsus Group Inc. All rights reserved
139
Clinician’s Corner
Case 4 Diagnosis: foreign body aspiration
The attending anesthetic team intubated her under bronchoscopic assistance. A small, white, rounded object was found in the right main bronchus, which on removal, was found to be a peanut. Her parents retrospectively recalled an episode of sudden violent cough when they were at a birthday party two months before this presentation. She made good recovery in the intensive care unit and was extubated 72 h later. She completed a seven-day course of intravenous antibiotics and was discharged home without any complications. Foreign body (FB) aspiration accounts for approximately 7% of accidental deaths among children
