Журнал «Здоровье ребенка» 6 (57) 2014

In clinical practice and in the literature of recent years aspiration of foreign bodies of the respiratory tract in children is an urgent and frequent problems. And one of the reasons for this are insidious "mask", followed by "hiding" the child's life-threatening and require emergency care, condition. According to statistics, 95-98% of cases of foreign body aspiration in children from 1.5 to 3 years. Small items in the airways at this age is dangerous by the fact that a child can not tell you what happened to him. This, along with other difficulties, also leads to late diagnosis, the development of complications, deterioration in the quality of life of the child and his family. The clinical picture of foreign body airway nonspecific varied, depending on the level of the respiratory tract lesions and the severity of symptoms can vary. There are cases when this condition generally does not manifest itself until the time when it is already being felt develop complications. This partly explains the fact that the number of patients diagnosed with late tracheobronchial foreign bodies remains high. The diagnosis is based on a set of anamnestic data, characteristics of the clinical course, percussion, auscultation and pictures of these additional studies, in particular X-ray. But the most reliable method of diagnosis and treatment is both endoscopic intervention.

As an illustrative example we present the case of our practice. K. girl, 6 years old, was admitted to the children's department of pulmonology CCCH number 3 at the beginning of May 2014 with complaints of prolonged cough with expectoration infrequent purulent sputum, intermittent mucous discharge from the nose, oral episodic wheezing. From history we know that the child is often sick bronchitis, underwent right-interstitial pneumonia. Is registered at the ENT doctor for chronic gaymoroetmoidita. In the latter peaking in February of this year when viewed diagnosed bronchitis, revealed changes in sputum, performed spirometry. A course Wilprafen, Pulmicort inhalation and beroduala, but without the desired effect. Suspected asthma. On admission the child is regarded as moderate severity due to the phenomena of bronchial obstruction. The department received treatment: fliksotid, berodual, Laferobion. But due to the lack of effect of the therapy is suspected foreign body airway. Underwent bronchoscopy where, found a foreign body left main bronchus myagkoelasticheskoy consistency. Microscopically detectable necrotic masses with large amounts of mucus and fibrin strands.

Clinical diagnosis of chronic bronchopulmonary process. Purulent endobronhit I-II degree after removal of foreign body left main bronchus. Hypergranulation left main bronchus. Bronchial asthma, mixed form for mild persistent, stage II, during an exacerbation.

The second case of a foreign body airway observed in late April 2014, when the department to exclude the diagnosis of asthma enrolled child O., 3 years old, complained of frequent cough, shortness of breath mixed character alone. On the background of acute respiratory viral infection in a child developed a cough, inspiratory dyspnea, wheezing remote. The child was hospitalized in a hospital in the community, where transferred to the pulmonology department of CCCH number 3. On admission the child moderate severity of symptoms due to respiratory failure. Remote oral wheezing, shortness of breath at rest mixed character. Assumed asthma. Received treatment: berodual, Pulmicort, saline with dexamethasone / drip, but the condition has not improved: dyspnea remained alone mixed character, remote wheezing, there was no effect when receiving β2 agonists short action. Suspected foreign body airway. Performed bronchoscopy, which resulted in a foreign body removed bronchus - a fragment of a nut shell.

Given the above, it should be noted that respiratory viral infection, persistent cough, bronchial obstruction or pneumonia, not amenable to classical therapy may be "undercover mask" has long been inspired by a foreign body. A child's early age, questionable radiologic imaging, and normal laboratory values ​​and history doubters parents should make the doctor think and assume tracheobronchial foreign body, and timely submission of such a child at diagnostic bronchoscopy to avoid complications and chronic process.