Subcutaneous emphysema and pneumomediastinum in child with asthma revealing occult foreign body aspiration: a case report

Abstract

Background Exacerbations of asthma constitute the most common cause of pneumomediastinum and subcutaneous emphysema in children. Foreign body aspiration is a rare cause of pneumomediastinum and subcutaneous emphysema. Foreign body aspiration leading to the occurrence of pneumomediastinum in a child with asthma may go unnoticed and be wrongly attributed to asthma, which leads to delayed diagnosis as well as to life-threatening and long-term complications. Case presentation We describe a case of a 6-year-old Moroccan boy with asthma who was admitted to our emergency department for acute dyspnea and persistent dry cough. The patient was initially treated as having acute asthma exacerbation. Owing to insufficient clinical and radiographic improvement with asthma treatment, a rigid bronchoscopy under general anesthesia was performed. A pumpkin seed was removed from the left main bronchus. Clinical and radiographic improvement was achieved after foreign body extraction. Conclusions This case emphasizes that the possibility of foreign body aspiration should always and carefully be considered by the emergency physician when faced with a child with asthma presenting with pneumomediastinum and subcutaneous emphysema as an important differential diagnosis even in the absence of a history of foreign body aspiration.

Misdiagnosed Tooth Aspiration in a Young Handicapped Boy: Case Report and Recommendations

“…Ninety percent of obstructions following tooth aspiration are situated in the distal airway and 10% in the upper airway [14], which means that the risk of development of fibrosis encapsulation and infections is high. Pneumomediastinum and subcutaneous emphysema may also occur, as described in an asthmatic young child after aspiration of a pumpkin seed [23]. Finally, Down syndrome patients are prone to infections because of their immune deficiencies, which could explain the severe pneumopathy developed by our patient [24].…”

Pneumothorax/pneumomediastinum as a complication of foreign body inhalation in 3 pediatric patients: A case series

“…[ 1 , 5 ] Furthermore, men showed a higher tendency to develop pneumomediastinum in all age groups than women. [ 5 ] Generally, pneumomediastinum is uncommon among children, and the most common causes among children are asthma exacerbation [ 8 , 9 ] and, very rarely, foreign body aspiration (FBA). [ 9 ]…”

“…[ 5 ] Generally, pneumomediastinum is uncommon among children, and the most common causes among children are asthma exacerbation [ 8 , 9 ] and, very rarely, foreign body aspiration (FBA). [ 9 ]…”

Spontaneous subcutaneous emphysema in a male toddler in a health facility in Nasarawa state: A case report

“…[5,6] e swelling can involve a different part of the body notably the chest, neck, scalp, trunk, and the upper limbs depending on the pathology and its severity. [5,[7][8][9] Coexistence of subcutaneous emphysema with pneumothorax or pneumomediastinum is more common in patients with acute exacerbation of bronchial asthma. [7,8] In addition, pneumothorax rarely complicates pneumonia among immunocompetent children.…”

“…[5,[7][8][9] Coexistence of subcutaneous emphysema with pneumothorax or pneumomediastinum is more common in patients with acute exacerbation of bronchial asthma. [7,8] In addition, pneumothorax rarely complicates pneumonia among immunocompetent children. [10] In this report, we describe a rare occurrence of extensive subcutaneous emphysema associated with pneumothorax in an 18-month immunocompetent toddler who was conservatively managed.…”