C l i n i c a l B r i e f Indian J Pediatr 1996; 63 : 816-818 i 71 i i i i i ii i i i i I i

Mummified Insect as Foreign Body in the Respiratory Tract

Anita Sharma, S. Tuteja*, K.N. Rattan** and R.K. Yadav***

*Department of Pediatric Medicine-II, **Pediatric Surgery and ***Radiodiagnosis, Post-graduate Institute of Medical Sciences, Rohtak, Haryana

Abstract. A case report of a child with a cockroach in bronchus is described. (Indian J Pediatr 1996; 63 : 816-818)

Key Words : Cockroach; Bornchus

Foreign bodies (FB) in the respiratory pas- sages of children are a common problem. Usually, aspirated FB are promptly diag- nosed mad removed. OccassionaUy, however, in the absence of a definite history of FB as- piration, the diagnosis may be delayed for weeks or years. The respiratory symptoms are often attributed to chronic illnesses like tuberculosis, asthma or bronchitis a-z. Vegeta- tive FB are the most commonly reported FB in children ~. We report a child who had a 2- year history of hemoptysis and recurrent pro- ductive cough prior to the discovery of an intrabronchial cockroach on bronchoscopy.

CASE REPORT

A 9-year-old boy presented in September 1991 with one-week history of hemoptysis. There was no history of fever, cough, breath- lessness, FB aspiration or chest pain. Systemic examination was normal.

On investigations tuberculin test (5 PPD units after 48 hours) was negative and X-ray chest PA view showed right lower lobe pneumonitis (Fig. 1). The child was advised

Reprint requests : Dr. Anita Sharma, 39/9J, Medical Enclave, Rohtak-124 001, Haryana.

Fig. 1. X-ray chest (PA view) showing pneumo- nitis right lower lobe.

antibiotics and to report for follow-up. How- ever, the child did not return till September 1993. During the 2 years interval the child had hemoptysis off and on with fever and productive cough. He had also received anti- tubercular drugs for 9 months and many courses of antibiotics during this 2-year pe-

1996; Vol. 63. No. 6 THE INDIAN JOURNAL OF PEDIATRICS 817

Fig. 2. CT-scan chest (contrast enhanced) showing lesion in poslerior segment of right lower lobe.

Fig. 3. Cockroach that was removed from bronchu~

riod. All the X-rays done during this period showed non-resolving pneumonitis of right lower lobe. A CT-scan of chest done in Janu- ary 1993, showed a non-enhancing (on con-

trast) lesion in the posterior segment of right lower lobe (Fig. 2). Except for crepitations in right side, the systemic examination was nor- maL

818 THE INDIAN JOURNAL OF PEDIATI~JCS 1996; Vol. 63. No. 6

Due to a non-resolving pneumonitis, the possibility of a FB was considered and bron- choscopy was planned, On bronchoscopy with a rigid bronchoscope, an intact mummi- fied cockroach 3-cm-long (excluding the length of bristles) and 1.5-cm-wide taken out from the right inferior lobar bronchus (Fig. 3). Three was no bronchial stenosis or inflamma- tion of surrounding tissue. Parents and child could not recall any history of choking, cough or respiratory distress. The postoperative period was uneventful and the child was dis- charged. For the last two years the patient is symptom free and the radiological lesion has also cleared.

Discussion

Although a number of fascinating varieties of FB have been described in respiratory pas- sages 2,4, an insect has been reported in only one other study s. Gokhale et al s, reported an acute respiratory arrest when a cockroach flew into the mouth of a child and entered the trachea. In the present case, neither the child nor the parents gave any history of aspira- tion, stridor, breathlessness, choking or cyanotic spell despite the large size of the FB. In 90% cases foreign bodies are coughed out by a strong cough reflex, and in 10% they may remain lodged in the airway 3~.

The initial symptoms of choking and gag- ging are practically never absent but may be ignored or unelicited by an incomplete his- tory or lack of suspicion of FB. After the ini- tial symptoms of aspiration there is a symptomless period which is followed by a symptomatic period. The commonest de- layed symptom is hemoptysis 4-6 as was in the present case. FB inhalation must be strongly suspected in children presenting with unex-

plained pulmonary symptoms such as unilat- eral wheeze, hemoptysis and recurrent pneu- monia occurring in the same lung a. To avoid chronic lung diseases even asymptomatic FB should be removed from the tracheo-bron- chial tree. Removal of FB is mainly per- formed with a rigid bronchoscope 9.

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