1. Aspirated Foreign Body
November 9, 2011

2. HPI 6 year-old boy previously healthy
Referred in 9/2011 for recurrent pneumonia
1st pneumonia in 3/2011
Left-sided
Diagnosed clinically and treated with Azithromycin

3. CXR 6/2011 2nd pneumonia in 6/2011 Fevers and cough
Treated with high-dose Amoxicillin
Left lower lobe and lingular pneumonia
Top edge of pneumonia very sharp – concern for mass vs round pna – should get a follow up CXR

4. Follow up CXR 7/2011
Interval resolution of left lower lobe pneumonia with residual patchy atelectasis versus scar and pleural thickening

5. HPI 3rd pneumonia in 9/2011 Fevers and cough
Treated with high-dose Amoxicillin
Left lower lobe pneumonia and pleural effusion

6. HPI No history of PNA prior to 3/2011 No history of other infections
No history of failure to thrive
No history of reactive airways disease or allergies
No antecedent choking or aspiration event

7. PMH Born full-term at BMC NKDA No Medications
Family History unremarkable
Social History
Lives with parents and five older siblings
No recent travel, no pets or smoke exposures
Parents from Somalia, no sick contacts

8. MGH Pulm Clinic 9/2011
O2 sat 99%, Wt 18.7kg (15%tile), Ht 115 cm (32%tile)
Exam
Well-appearing
No LAD
Decreased breath sounds on left
No crackles or wheezes
No clubbing of extremities

9. Chest CT 9/2011
Consolidation and atelectasis involving the lingula and inferior basilar portion of the left lower lobe with bronchiectasis and mild pleural thickening
No obstructing airway abnormality
Mediastinal and bilateral hilar adenopathy

10. DDx
6 year old M previously healthy with recurrent LLL PNA and bronchiectasis on chest CT
Aspirated foreign body
Immunodeficiency TB CF
Pulmonary sequestration
Post-infectious bronchiectasis
?Previous adenoviral infection
Normal newborn screen and growth, location of bronchiectasis 10

11. Labs PPD negative CBC normal Chem 10 normal
Immunoglobulins and subclasses normal
Strep pneumo/Hib/Tetanus vaccine titers normal
Fungal studies negative

12. Bronch 9/11
RML
RLL
Trachea 12

13. Lingula
Foreign material removed via forceps

14. Lingula

15. Corn POPS or Popcorn??

16. Results BAL Negative for Mycobacteria Negative for fungus
42N, 21L, 4M
Negative for Mycobacteria
Negative for fungus
Cultures grew Moraxella and normal oral flora
Endobronchial biopsy of lingula
No malignant cells on cytology
Granulation tissue with xanthogranulomatous infiltrates, multinucleated giant cells and hemosiderin-laden macrophages
Patient did well following procedure
Signs of inflammation from foreign body 16