Missed Distal Tracheal Foreign Body in Consecutive Bronchoscopies in a 6-year-old Boy.

It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals. He had an initial rigid bronchoscopy which failed to show the foreign body (FB). A chest computerized tomographic scan demonstrated the FB, which was retrieved at combined flexible/rigid bronchoscopy. Although rigid bronchoscopy is the gold standard for managing airway foreign bodies, there remains a false negative rate for this procedure and where necessary, appropriate imaging may compliment rigid bronchoscopy, especially where there is some confusion.

Prevalence and patient characteristics associated with pleural tuberculosis in Nigeria.

BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. The pleural space is a common extrapulmonary site of involvement. The aim of this paper is to document prevalence and types of pleural involvement in pulmonary tuberculosis and patient characteristics associated with its occurrence. METHODOLOGY: The study was conducted in a hospital outpatient clinic in which consecutive patients with pulmonary tuberculosis (PTB) or suspects were recruited and studied for the presence of co existing pleural disease or involvement (PD). RESULTS: Of 100 patients studied, eighty-two (82%) had PTB alone and six (6%) patients had PD. Pleural effusion was responsible for the majority of the cases, accounting for 67% of PD. There was no case of empyema. Mean age between patients with PTB and PTB/PD was similar. On univariate analysis, patients with PD had a shorter duration of symptoms and increased reporting of fever (p value = 0.02) and were also different from those with only PTB in HIV seropositivity and sputum smear from AFB (p value = 0.02 and 0.00 respectively). However, after adjustment for multiple comparisons using the Bonferroni test, the only significant difference between them was in the HIV seropositivity rate (p value < 0.012). CONCLUSION: Less than one tenth of patients with PTB have co-existing and involvement of the pleural space. Pleural involvement is associated with HIV.