Extrinsic bronchial compression by primary tuberculous adenopathy, simulating foreign-body aspiration

Pitcher, Richard; Hewitson, John

Extrinsic bronchial compression by primary tuberculous adenopathy, simulating foreign-body aspiration

Journal Article

2005

Journal Title

South African Medical Journal

Link to Journal

http://www.samj.org.za

Publisher

University of Cape Town

Department

Division of Paediatric Surgery

Faculty

Faculty of Health Sciences

Abstract

A 5-month-old boy was well until the day before admission, when he developed a cough. On the morning of admission he was irritable and his mother noticed a blue tinge to his lips during episodes of crying. This prompted her to bring him to the emergency unit at Red Cross Children's Hospital, where he was found to be distressed and cyanosed, with a respiratory rate of 60 beats per minute, a heart rate of 200/minute and alar flaring. His left chest showed decreased air entry, bronchial breathing and dullness to percussion. Oxygen saturation was 66%, improving to 88% on face-mask oxygen. His weight was on the 50th percentile. He was well hydrated, well perfused and had no significant background medical history. A mobile chest radiograph (Fig. 1) showed complete opacification of the left hemithorax, mediastinal deviation to the left and overexpansion of the right lung, which had herniated across the midline. A penetrated anteroposterior (AP) chest radiograph (Fig. 2) showed abrupt 'cut-off' of the left main bronchus.