A 9-month-old boy presented to the emergency department with acute wheeze. He had a background of cleft lip repair at 4 months and was awaiting palatoplasty. He had mild eczema but had never had a previous wheezy episode, and was awaiting cardiology follow-up for a small patent ductus arteriosus (PDA). He had been at the child minder when symptoms began abruptly with no witnessed event. On assessment, the wheeze had resolved, saturations were 98% breathing air, respiratory rate was 34 breaths per minute and he was afebrile. He was discharged home with safety net advice.
He represented 2 days later with cough, wheeze and shortness of breath. On examination, he had subcostal recession and there was reduced air entry on the right. There was no wheeze, crepitations or obvious organomegaly. Oxygen saturations were 98% breathing air, respiratory rate was 38 breaths per minute and he was afebrile. Oral amoxicillin was given.
Given the history what is the likely diagnosis?
Congestive heart failure
Foreign body aspiration
Reactive airways disease
Which investigation would be most useful at this stage?
Point-of-care respiratory strip
What is the next step in the management?
Oral steroids and inhaled bronchodilator
What are the long term complications of an undiagnosed foreign body?
Questions Answers can be found on page 2.
- foreign body aspiration
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Correction notice This paper has been corrected since it was published online. The abstract should not have been included in the published version and this has been removed.
Contributors SM wrote the first draft. All other authors reviewed the manuscript and agreed on the final version for submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.