Subcutaneous Emphysema and Pneumomediastinum in Asthmatic Child Revealing an Occult Foreign Body Aspiration

The most common cause of pneumomediastinum and subcutaneous emphysema in children is represented by exacerbations of asthma. Foreign body aspiration is a rare cause of pneumomediastinum and subcutaneous emphysema. Foreign body aspiration leading to pneumomediastinum presenting in a child with asthma, may go unnoticed and be wrongly attributed to asthma, which engenders diagnosis delay, life threatening, and long-term complications.

We describe here a case of a 6 year-old asthmatic male who presented to our emergency department for acute dyspnea and persistent dry cough. The patient was initially treated as an acute asthma exacerbation. Due to insufficient clinical and radiographic improvement with asthma treatment, a rigid bronchoscopy under general anesthesia was performed. A pumpkin`s seed was removed from the left main bronchus. There was a clinical and radiographic improvement after foreign body removal.

This case emphasizes that the possibility of foreign body aspiration should be always carefully considered by the emergency physician in asthmatic child presenting with pneumomediastinum and subcutaneous emphysema as an important differential diagnosis in spite of the absence of history of foreign body aspiration.