A 3-year-old girl suddenly had a dry, obsessive cough in the midst of

A 3-year-old girl suddenly had a dry, obsessive cough in the midst of complete health. In dynamics, the paroxysmal cough periodically resumed, especially when the body position changed It is known from the anamnesis that the child does not suffer from any bronchopulmonary diseases. Parents also note that the child often plays with small toys. On examination: the child is conscious. Above the lungs, the percussion sound is not changed Breathing is carried out evenly on both sides. The heart tones are sonorous, rhythmic. Heart rate - 100 beats / min, blood pressure-95/55 mm.hg. The abdomen is soft and painless. The liver is at the edge of the costal arch. General blood erythrocytes-4.0x10'2/1, Hb-118 g/l, thrombocytes -260.0x10/1, leukocytes-7.6×10/1, stab neutrophils-2%, segmented-45%, lymphocytes-53%, ESR-6 mm/h.

Reading File

Finding Sources

Reading File

This is a classic case of foreign body aspiration (FBA) in a toddler. Here is a full clinical analysis:

Diagnosis: Foreign Body Aspiration

Why this diagnosis fits

Feature	Significance
Age 3 years	Peak age for FBA (children <3 years most susceptible)
Sudden onset dry, paroxysmal cough in full health	Classic presentation — abrupt choking/coughing episode
Cough recurs with position changes	Foreign body shifts within airway with movement
Plays with small toys	Direct risk factor — inorganic foreign bodies (toy parts, beads, coins)
No prior bronchopulmonary disease	Excludes asthma, bronchitis, or chronic lung pathology
Symmetric breathing, normal percussion	Partial obstruction without complete lobar collapse
Normal CBC / ESR	No infection, no eosinophilia — against allergic or infectious cause

Classic triad of FBA: paroxysmal cough + wheezing + decreased air entry (present in <40% of cases). This child shows the cough component; the others may be absent with a smaller or more distal object.

Pathophysiology

A foreign body lodged in the tracheobronchial tree causes:

Irritant-reflex cough (dry, non-productive) from mucosal stimulation
Positional variability — the object shifts with gravity or posture, intermittently partially obstructing the lumen and triggering coughing spells
Most common location: right main bronchus (45–57%), then left main bronchus, then trachea — due to the more vertical angle of the right bronchus

Immediate Management

Chest X-ray (PA view, including neck):
- Radiopaque objects (coins, metal) will be visible directly
- Radiolucent objects (plastic toys, nuts) leave indirect signs: unilateral air trapping, mediastinal shift away from the affected side, or segmental atelectasis
- Consider inspiratory + expiratory films (or bilateral lateral decubitus in young children) to demonstrate air trapping — the affected lung remains hyperinflated on expiration
- A normal chest X-ray does NOT rule out FBA
Urgent bronchoscopy — definitive diagnosis and treatment
- Rigid bronchoscopy under general anesthesia is the gold standard for both visualization and removal
- Flexible bronchoscopy may be used for diagnosis if the object is suspected distal
Do NOT perform blind finger sweeps; do not aggressively cough-suppress (coughing is protective)
If the child stops breathing or becomes unresponsive: Heimlich maneuver (abdominal thrusts) in children >1 year; CPR if unresponsive

Differential Diagnoses to Consider (but less likely here)

Croup — typically has barking cough + stridor + viral prodrome
Asthma — no prior history, no wheezing, normal blood work
Pneumonia — normal temperature, normal CBC, normal percussion
Pertussis — no characteristic whoop, no lymphocytosis

Bottom line: This child requires urgent evaluation with chest X-ray and likely rigid bronchoscopy. The combination of sudden-onset positional cough in a previously healthy toddler who plays with small toys is foreign body aspiration until proven otherwise.

— The Harriet Lane Handbook, 23rd ed.; Tintinalli's Emergency Medicine

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