Total Opacification of the Left Hemithorax after Relief of Endobronchial Obstruction by Foreign Body—A Case Report

Abstract

We report the case of a 2-year-old boy who aspirated a fragment of a walnut and shell. Two days after the incident, the child was in respiratory distress and was referred to our medical center. Rigid bronchoscopy was performed, and the foreign body was removed from the left main-stem bronchus; however, the left chest failed to expand fully with positive-pressure ventilation. An intraoperative radiograph revealed complete opacification of the left lung, suggestive of unilateral pulmonary edema; however, leftward mediastinal shift was suggestive of massive atelectasis and lung collapse. Repeat bronchoscopy failed to reveal additional foreign bodies; however, airway edema was observed, and a copious amount of clear serosanguinous fluid was suctioned from the left main-stem bronchus. Reexpansion of the left lung occurred following administration of nebulized racemic epinephrine. An understanding of the physiologic changes associated with endobronchial obstruction and relief of such obstruction is prerequisite to providing appropriate therapy based on radiologic and clinical monitoring during perioperative management of endobronchial foreign-body obstruction.