Diagnostic difficulties of foreign body aspiration in children.

A case of a 4-year-old child who aspirated a 22-caliber bullet is presented to illustrate the variability of signs and symptoms of foreign body aspiration. Despite the large size of the bullet, cough, dyspnea, and wheezing were absent on presentation. Chest roentgenogram confirmed the diagnosis of a radiopaque bronchial foreign body. A retrospective review of 42 additional children with foreign body aspiration showed 8 (19%) were unwitnessed, 24 (57%) were asymptomatic at presentation, 8 (19%) had normal physical examinations, and 10 (24%) had normal inspiratory/expiratory chest roentgenograms. This demonstrates the importance of considering bronchoscopy for any child who presents with a history of possible foreign body aspiration, but is asymptomatic and has normal roentgenographic findings.