BACKGROUND Foreign body aspiration (FBA) is a life-threatening pediatric emergency, most common in 1-3-year-olds due to immature swallowing reflexes and exploratory oral behaviors. Common aspirated items include nuts, food particles and small toys, presenting with variable symptoms such as cough, dyspnea, wheezing or acute respiratory failure. Delayed diagnosis or improper management causes severe complications like post-obstructive pneumonia, atelectasis, bronchiectasis and irreversible airway stenosis, increasing morbidity and treatment complexity. CASE REPORT A 16-month-old girl was admitted with persistent cough, progressive dyspnea, intermittent fever, hoarseness, and occasional cyanosis that developed 6 days after accidental pine nut ingestion. Initial flexible bronchoscopy at a local hospital failed due to the foreign body's rigid texture and deep impaction in the right lower lobe basilar bronchus. Chest CT confirmed a pine nut shell in the B9/B10 segmental bronchus with surrounding inflammation. She was transferred for combined rigid-flexible bronchoscopy to establish a secure airway and enable precise visualization before holmium laser fragmentation broke the shell into retrievable fragments for complete removal. Two-week follow-up showed symptomatic B9/B10 stenosis, which improved significantly after sequential 3.5 mm and 4.0 mm balloon dilation. Her respiratory symptoms resolved and imaging confirmed restored lobar ventilation. CONCLUSIONS Rigid-flexible bronchoscopy synergy benefits removal of large rigid foreign bodies in sub-main bronchi by combining rigid bronchoscopy's airway security with flexible bronchoscopy's maneuverability and visualization. Holmium laser safely fragments hard foreign bodies with minimal airway trauma, and sequential balloon dilation effectively treats post-FBA stenosis. Individualized application guided by clinical assessment and imaging optimizes pediatric FBA outcomes.

Foreign body aspiration among adults and older children could be more common than previously documented. We present below eight cases of incidentally found airway foreign bodies (FB) during endoscopic evaluation of patients performed due to various indications such as chronic cough, nonresolving pneumonia and suspected malignancy, among others. A high index of suspicion and prompt management are required to prevent morbidity and complications associated with long-standing airway FB.

In children with complete unilateral main bronchial obstruction from foreign body aspiration, positive pressure ventilation may overdistend the contralateral ventilated lung, leading to barotrauma and tension pneumothorax. Sudden hypoxemia and hypotension should prompt rapid clinical assessment, including lung ultrasound, and immediate decompression.

Dental aspiration is usually reported in children with underlying disorders, such as neuromuscular disorders, and is rare in healthy children. Although foreign body aspiration typically causes a persistent cough in infants, herein we report a healthy adolescent whose persistent cough was due to dental aspiration.

Capsule endoscopy (CE) aspiration is extremely rare (0.003%-0.013%) but potentially life-threatening. The CE is structurally challenging for standard bronchoscopic removal due to its large size, smooth surface and nonmetallic composition. While most aspirated capsules remain in the central airways, reports on peripheral impaction are limited. We report a case in which a CE was impacted deep within the right basal segmental bronchus of a man in his 70s. Conventional forceps manipulation failed because the capsule was completely impacted, preventing visibility beyond the obstruction. We successfully employed a two-step strategy: (1) disimpaction using a balloon catheter guided by fluoroscopy and (2) retrieval in the central airway using a retrieval loop net. This fluoroscopy-assisted two-step strategy provides a safe and reliable approach for retrieving structurally challenging foreign bodies in the peripheral airways.

Background Foreign body aspiration (FBA) is a common pediatric emergency, particularly in children under five, due to immature airway protection reflexes and their tendency to explore objects orally. It is the fourth leading cause of accidental death in children under three, making early diagnosis and prompt management crucial. Objective To assess the profile of pediatric patients requiring bronchoscopy, identify associated clinical presentations, evaluate complications, identify the types of foreign bodies, and the most frequent site of lodgment. Method Clinical data of three years, from April 2021 to April 2024, were retrospectively collected from medical records. The study included children below 14 years of age who underwent rigid bronchoscopy for suspected foreign body aspiration at a tertiary care center. Their clinical profiles and various presenting symptoms were analyzed. Result Among 37 cases, the highest incidence (43.2%) was in children aged 1-3 years, with males comprising 73%. Cough and wheezing were the most common symptoms (19 cases). Organic foreign bodies, mainly peanuts and beans, were found in 22 cases, while metallic sharp objects (pins) were present in 5 cases. The right main bronchus was the most affected site (22 cases), and post-procedural pneumonia developed in 5 cases. Conclusion Foreign body Aspiration predominantly affects young children, with organic objects being the most common. Rigid bronchoscopy remains the gold standard for diagnosis and treatment, emphasizing the need for early intervention to prevent complications.

The aspiration of exfoliated primary teeth is extremely rare yet presents a high risk for aspiration pneumonia. This is the first reported case in a child with no underlying conditions. Expertise in the removal of foreign bodies is vital for an optimal treatment outcome and should be performed at specialist centers.

Foreign body aspiration is common in pediatric setting and in chronic cases such patients often present with clinical features similar to infective respiratory etiologies. This is the case of a forgotten left bronchial foreign body in a 5-year-old girl, who presented with worsening of recurrent cough and fever. She was previously being treated as case of bronchial asthma and foreign body was missed on the imaging as well. It was subsequently expelled by chest physiotherapy. The case highlights the importance of having foreign body aspiration (FBA) as a differential in cases of chronic cough, even without any history of choking, to avoid diagnostic challenge. Moreover, spontaneous expulsion of foreign body was incidental clinical event and is not substitute for standard clinical care.

Failure to improve after initial management in infants with suspected foreign body aspiration and apparent tension pneumothorax should prompt reconsideration of the diagnosis, including underlying congenital lung anomalies such as CPAM.

Foreign body (FB) ingestion is a frequent clinical occurrence, but most objects pass spontaneously without complication. Sharp foreign bodies, particularly fish or chicken bones, significantly increase the risk of esophageal perforation, a rare but potentially fatal event. This report describes a 45-year-old woman who presented repeatedly with sore throat, dysphagia, low-grade fevers, weight loss, and a palpable cervical mass after ingesting a chicken bone. Initial evaluations were unrevealing. On gastroenterology referral, her exam revealed left cervical swelling, endoscopy demonstrated purulent drainage from the proximal esophagus, and bedside ultrasound uncovered a complex peri-esophageal fluid collection with air pockets and a suspected retained FB. Aspiration produced purulent fluid concerning an esophagocutaneous fistula. Surgical exploration revealed a deep cervical abscess, and a chicken bone fragment was removed. The esophageal defect was repaired with muscle flap interposition, and a gastrostomy tube was placed for feeding. The patient recovered well, with no postoperative leak on barium swallow. This case highlights the diagnostic challenges of cervical esophageal perforation, particularly when early symptoms are nonspecific and initial imaging is negative. A bedside ultrasound proved valuable in identifying the retained FB and guiding timely intervention. Although delayed diagnosis increases risk, coordinated multidisciplinary management can still achieve excellent outcomes, as shown by this.

Foreign body aspiration (FBA) is a well-recognized pediatric emergency that is frequently misdiagnosed due to symptom overlap with common respiratory conditions such as bronchiolitis, asthma and pneumonia. This case report describes a toddler with recurrent wheezing and cough that persisted despite standard medical therapy. The child was evaluated at a pediatric urgent care center in which history, physical exam findings and imaging raised concern for airway obstruction. The child was transferred to a pediatric emergency department for suspected FBA prompting bronchoscopy evaluation, with confirmed and removed an aspirated foreign body. This case highlights the diagnostic challenges of FBA and reinforces the importance of maintaining clinical suspicion when respiratory symptoms fail to improve as expected. Early recognition, appropriate imaging, and prompt intervention remain essential to prevent complications.

A 3.5-year-old female neutered Abyssinian cat was referred for investigation of a 2-week history of lethargy and intermittent vomiting, with recent development of diarrhoea, hyporexia, pyrexia, abdominal pain, moderate anaemia, hyperglobulinaemia and a palpably enlarged spleen. Abdominal ultrasound revealed a nodular spleen, and cytology identified septic splenitis (cocci were seen within neutrophils following fine needle aspiration). After 72 h of intravenous amoxicillin and clavulanic acid (20 mg/kg, per os, every 8 h), lack of clinical improvement prompted exploratory laparotomy and splenectomy. Histopathology was compatible with a suppurative to pyogranulomatous splenitis and identified intralesional bacteria. Bacterial culture of abdominal effusion and splenic biopsies grew Staphylococcus pseudintermedius resistant to benzylpenicillin. After surgery, the cat was treated with a 4-week course of the fluoroquinolone pradofloxacin (5 mg/kg, per os, every 24 h) and made a complete recovery. Septic splenitis is an uncommon diagnosis in the veterinary literature, being limited to eight splenic abscesses in cats, rare reports in dogs and a case of splenic foreign body in a cat and a heifer. To the authors' knowledge, this is the first description of the successful management of septic splenitis in a cat not secondary to a foreign body. This case highlights that splenectomy should be considered the treatment of choice in the absence of response to antibiotic treatment and that antibiotic choice should be guided by antibiotic susceptibility results.