The Diagnostic Challenge of Sharp Foreign Body Aspiration in Children: A Two-Case Series Highlighting Ingestion vs. Aspiration

Introduction: Foreign body aspiration (FBA) is a common pediatric emergency.Sharp objects, such as pins, pose a unique risk of perforation and migration.Clinically, differentiating between aspiration and ingestion can be challenging, as symptoms and radiological findings may overlap, particularly for objects lodged in the mediastinum.Case Presentations: We present two cases of sharp foreign body aspiration in school-aged children.Case 1: A 10-year-old girl presented acutely with chest pain after inhaling a headscarf pin.Chest X-ray showed a mediastinal radio-opaque shadow, creating a diagnostic dilemma between bronchial and esophageal localization.Rigid bronchoscopy confirmed the pin in the left main bronchus, and it was successfully removed.Case 2: A 14-year-old boy presented with delayed hemoptysis two months after aspirating a blunt-tip sewing needle.Initial rigid bronchoscopy was unsuccessful, necessitating flexible bronchoscopy for retrieval from the left upper lobe. Conclusion:These cases highlight that sharp FBA can occur in older children and may present with atypical, delayed symptoms.The initial radiographic localization to the mediastinum often complicates the diagnosis, blurring the line between aspiration and ingestion.A high index of suspicion, coupled with a detailed history, is paramount.The choice of endoscopic technique must be tailored to the location and nature of the foreign body.This series underscores the need for heightened awareness of this preventable hazard.