It is an unusual FBA presentation mimicking cavitary tuberculosis in an adolescent patient with long duration of respiratory symptoms and recurrent pulmonary infections on the same side of the lung even with the absence of a history of choking. Foreign body aspiration is a common medical emergency with serious airway obstruction and sudden respiratory distress occurs immediately in complete obstruction. If the obstruction is incomplete foreign body becomes lodged, progressive respiratory symptoms such as chronic cough, wheezing, hemoptysis, pneumonia and atelectasis can develop and the diagnosis is usually delayed. Chest radiographs are commonly performed in children with suspected FBA, and may show unilateral or lobar hyperlucency, localized atelectasis, and localized pulmonary infiltrate. However, a normal radiograph could not exclude FBA [2, 9, 10]. Our patient is an example of delayed diagnosis and misinterpreted as pneumonia and cavitary tuberculosis.
The type of the foreign body depends on cultural, social and economic factors and eating habits. Children younger than 3 years old have considerable risk of foreign body aspiration because of the tendency of using their mouths to explore their surroundings. At this stage of development, the main objects aspirated are vegetable originated seeds, peanuts and toy parts [3, 7, 8]. Also in our country safety pins ingestion among 4 months -2 years old children were reported [4]. Aspiration of sharp, metallic objects such as needles, toothpicks, safety pins in toddlers” age and early childhood period were also reported [4]. In school aged or adolescent period, the most common material aspirated are blow dart, thumbtack, darting pin, and headscarf needles [3, 5, 6]. Our patient had aspirated thread, an unusual material that was not reported in adolescent period before.
As a result, FBA is one of the life threatening emergency that may happen at any age. The misleading cases without aspiration history present with recurrent or persistent pulmonary symptoms. Bronchiectasis and atelectasis can be seen in diagnostic delayed cases as usual but cavitary lesion mimicking tuberculosis is an atypical presentation [2, 9]. If the diagnosis is delayed and symptoms and signs are not specific for any disease, flexible bronchoscopy is needed to evaluate directly in such cases.
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