Case History: 2-year-old female with complains of difficulty breathing, paroxysmal coughing, and wheezing for one day. The problem began after alleged ingestion of possible groundnut seed as reported by the parents.
The problem began after alleged ingestion of possible groundnut seed as reported by the parents.
Figure 1. X-Ray chest AP view: A linear streaky lucency is noted along the left heart border (yellow arrow) with linear lucency also along the extra-pericardial great vessels in superior mediastinum and neck, giving rise to “tubular artery sign,” (blue arrow). Generalized radiolucency is noted involving the right lung field as compared to left side, suggestive of hyperinflation (green arrow). Foreign body was suspected.
Figure 2. High resolution min IP (lung window) axial and coronal images: Hyperdense material within right main stem bronchus (5-6 mm away from carina) causing complete luminal narrowing (yellow arrow). Pneumomediastinum is noted around heart (blue arrow). Patch of consolidation is noted in posterior segment of right upper lobe (green arrow).
Figure 3. Contrast (soft tissue window) axial and coronal images: Small non-enhancing soft tissue obstructing right main bronchus with significant soft tissue emphysema along the great vessels of neck dissecting into deeper planes.
Figure 4: Virtual bronchoscopy image: Shattered pieces of probable ground nut seed (as elicited by history) plugging right main bronchus.
Diagnosis: Pneumomediastinum
On flexible bronchoscopy: Shattered pieces of groundnut seed with edema of surrounding bronchial mucosa were noted
Pneumomediastinum is the presence of air or other gases in the mediastinum (also known as mediastinal emphysema).
In this case, the significant pneumomediastinum noted is probably due to Macklin effect.
In a child younger than 5 presenting with acute onset breathlessness, coughing, wheezing and having pneumomediastinum prior to bronchoscopy should prompt the diagnosis of foreign body aspiration.
