Occult foreign body airway in children – Case series with review of literature

Foreign body aspiration (FBA) in children is a common public health issue that can present as a clinical emergency. However, long-standing occult foreign bodies (FBs) in the airway pose a diagnostic challenge, often mimicking common respiratory illnesses. Despite regular education on child safety, such cases are frequently encountered in clinical practice. This paper emphasises the need for a high index of suspicion for FBA when evaluating children with chronic respiratory symptoms presented through three cases with varying clinical presentations and outcomes. Case 1, a 7-year-old girl presented with chronic cough, was misdiagnosed as pulmonary tuberculosis and was on antitubercular therapy for 3 months without any response to treatment before visiting our hospital. Case 2, a 2-year-old boy, presented as hyperreactive airway disease and was under regular treatment with bronchodilators and inhaled corticosteroids in the past 2 months. Case 3, a 9-year-old girl, presented with a chronic cough and was on oral antibiotics for recurrent lower respiratory tract infections for 1 month. All three cases underwent radiological evaluation followed by rigid bronchoscopy in view of a high index of suspicion of occult long-standing airway FB. Although organic FB (areca nut) was retrieved in the first two cases, we lost the first case to complications (hypoxic ischaemic injury) during the procedure. The second case improved well after the FB removal. The third case continued to experience a chronic cough, which was well-managed with bronchodilators on follow-up. A literature review was performed through the MEDLINE database using a few key terms: ‘Airway foreign body’, ‘long-standing foreign body airway’, ‘chronic cough’ and ‘rigid bronchoscopy in children’. We focused on presentation and management of occult long-standing airway FB in children, with practical aspects on prevention. The three cases presented here further emphasise the clinician to consider occult FB airway as a differential diagnosis in the evaluation of any child with chronic cough. This literature review aims to present the recent scientific literature and provide a clear practical guide on the approach towards long-standing airway FB in children.