Esophageal Foreign Body vs Asthma

To the Editor: Foreign body aspiration and ingestion in adults and in children have a variety of clinical symptoms and can be unrecognized for some time.1 The peak incidence of foreign body aspiration occurs during the second year of life in children and during sixth decade in adults.2

Foreign body ingestion and aspiration in the pediatric population can cause wheezing and be diagnosed and treated as bronchial asthma by the primary care physician.3,4 We have had many children come to our institution and undergo radiographic examination for an unrelated medical condition, only to reveal an esophageal foreign body.

We describe an 11-month-old patient who was treated for bronchial asthma for several weeks. He came to the ear, nose, and throat clinic with a history of snoring and acute recurrent otitis media. A lateral neck radiograph to evaluate adenoid size showed a metallic foreign body at the thoracic inlet. A detailed history disclosed that the child had a wheeze and had been treated for asthma within the month before his clinic visit. The parents related the possibility of coin ingestion a few weeks earlier. After an endoscopic removal of the coin, the symptoms of asthma disappeared. Partial or even complete esophageal blockage with superimposed edema of the esophageal wall and adjacent tracheal tissue can mimic symptoms of asthma. Additionally, esophageal wall edema can cause pooling of secretions, which can lead to aspiration with worsening symptoms.

We suggest that if ingestion of a foreign body is suspected in a pediatric patient, the child should be completely evaluated, including a chest radiograph, before labeling the symptoms to be due to asthma.