IntroductionForeign body aspiration is a common occurrence in children, especially among those younger than 3 years of age and is a potentially life-threatening event. Chronic debilitating symptoms with recurrent infections might happen with delayed diagnosis.Case reportA 1 year 7 months old boy was admitted with a 2 month history of recurrent episodes of productive cough and high fever, progressive worsening despite empirical antibiotic therapy, with severe dyspnea, intense coughing and perioral cyanosis. His symptoms have followed a choking episode while eating sunflower seeds, ignored by the parents. Physical examination revealed a well-nourished child, in moderate respiratory distress, tachypnea, persistent productive cough, dullness to percussion and abolished breath sounds of inferior half of the left lung field and crackles, bronchial breathing in the upper half. Oxygen saturation and other systemic examination were normal. Laboratory investigation showed leukocytosis, neutrophilia, severe inflammatory syndrome, and the chest x-ray with completely opaque left hemithorax. We presumed the diagnosis of bronchial foreign body aspiration and started medical treatment with complex systemic antibiotic, antimycotic, bronchodilator and anti-inflammatory agents. Rigid bronchoscopy revealed significant stenosis of the left main bronchus, possible granuloma, mucosal oedema, bronchiectasis with thick secretions and a vegetable foreign body which was removed. During the examination, a large quantity of foetid mucopurulent liquid was drained. Other two successive bronchoscopies were necessary for bronchoalveolar lavage. Bronchial aspirate culture was positive for Acinetobacter baumanii. Thoracic CT confirmed significant stenosis and complete atelectasis of the left lung, with air leakage areas included. The medical treatment was continued and the patient was discharged with clinical and laboratory improvement of his condition. Though, chronic bronchial obstruction with bronchiectasis and destruction of lung parenchyma requires surgical care. Pneumectomy versus inserting a bronchial stent are yet to be discussed.ConclusionDelayed diagnosis of foreign body aspiration may associate serious complications, particularly for vegetable matter, being responsible for intense inflammatory response and bronchopulmonary suppurations. Careful anamnesis is required to identify those needing additional investigation for early diagnosis.

IntroductionInterstitial lung disease in infants represents a heterogeneous group of diffuse pneumopathies causing chronic respiratory symptoms, associated with high mortality and morbidity. It is rare in children and differs considerably in aetiology and pathogenesis compared to adults, being a real diagnosis and therapeutic challenge.Case reportA 8 months old girl, with no history of prematurity and normal neonatal adaptation, but with significant personal history of neurodevelopment delay and recurrent bronchiolitis, was admitted with high fever, persistent cough, severe expiratory dyspnea and generalised cyanosis. Physical examination revealed an underweight child, with moderate axial hypotonia, in severe respiratory distress, tachypnea, wheezing, retractions, oxygen desaturation, symmetric breath sounds, multiple crackles, persistent cough, tachycardia, with no cardiac murmurs, digital clubbing, difficulty in feeding. Laboratory tests showed respiratory acidosis, hypercapnia and the chest x-ray with large opacity in the right superior lobe, diffuse alveolar infiltrates. Oxygen, systemic antibiotic, anti-inflammatory, bronchodilator and diuretic agents were initiated, with rapidly worsening of general condition, requiring prolonged mechanical ventilation. Echocardiography revealed moderate pulmonary hypertension and large patent ductus arteriosus, for which surgical ligation was performed, with favourable evolution, including pulmonary hypertension remission. However, despite of clinical and laboratory improvement in patient condition, any attempt to extubation lead to severe hypercapnia. In order to stop mechanical ventilation, a tracheostomy was performed. Altough successful extubation, the oxygen dependence persisted. We excluded the most common oxygen dependent respiratory diseases, after surgical treatment of congenital heart disease: cystic fibrosis, pulmonary hypertension, recurrent aspiration, immunodeficiency and neuromuscular disorders. Thoracic CT revealed atelectasis of right superior lobe, diffuse ground glass attenuation, linear opacities and honeycombing, suggestive for interstitial pneumopathy. Lung biopsy and histological diagnosis are yet to be performed. The patient was discharged with oral corticotherapy and continuous oxygen therapy.ConclusionWe presented a case of an infant with chronic respiratory failure, apparently secondary to congenital heart disease and recurrent bronchiolitis.