Pediatric foreign body and an unusual x-ray finding.

An 8-month-old girl was brought to an outside hospital after she had experienced a choking episode shortly after feeding. She had not experienced any apnea or cyanosis. Her mother noticed a different pitch to her cry. The child had been born at term. She had been previously healthy, and her immunizations were up to date. She lived with her mother in an older house.

On physical examination, the patient was resting comfortably in her mother's arms. The child's chest movement was symmetric, and no retractions, stridor, or drooling were evident. On auscultation, the lungs were clear bilaterally. Lateral (figure 1, A) and anteroposterior (figure 1, B) chest and neck films were taken, and a foreign body was seen on the anteroposterior view.

[FIGURE 1 OMITTED]

The patient was taken to the operating room, where direct laryngoscopy (figure 2) and bronchoscopy were performed. A paint chip was retrieved from the glottis. Findings on the remainder of the examination were negative. The patient made an uneventful recovery, and the mother was educated about the hazards of lead paint.

[FIGURE 2 OMITTED]

This case clearly shows the value of always obtaining both lateral and anteroposterior views on plain films. In this case, the density of the paint chip on the lateral view was not sufficient to produce a diagnostic radiographic shadow, but the chip was clearly visible on the anteroposterior view. This case also reinforces the importance of maintaining a low threshold for taking a patient to the operating room to perform both diagnostic and potentially therapeutic direct laryngoscopy and bronchoscopy.

Bart Patenaude, MD; Steven Chase, MD; Marcella Bothwell, MD

From the Department of Otolaryngology Head and Neck Surgery, University of Missouri Hospital, Columbia.