A 6-year-old boy presented to our hospital with recurring breathlessness and cough of 2 months. He told his parents he accidentally aspirated the base cap of a pen, subsequently developing breathlessness and cough. He was immediately taken to a private health facility where he had an emergency rigid bronchoscopy, but the FB was not found. He was given medications, got slightly better, and discharged home. He re-presented at two tertiary hospitals where repeat bronchoscopies were performed 4 weeks apart which failed to demonstrate any FB. He was diagnosed to have asthma, treated accordingly, and improved symptomatically on bronchodilators.
He was admitted at our hospital following symptom recurrence. A chest x-ray done at presentation appeared normal and repeat rigid bronchoscopy was performed at his parents' request. A pedunculated subglottic mass was identified and excised. The patient improved remarkably and was discharged home 24 h later. Histology of the mass was reported as fibrocartilaginous tissue devoid of epithelium.
About 2 weeks later, he re-presented with severe respiratory distress. A neck and chest CT was requested which demonstrated a thin mass just above and straddling the carina [Figure 1].
He had repeat combined flexible and rigid bronchoscopy which identified the FB covered with granulation tissue which was then successfully extracted [Figures 2 and 3]. Postbronchoscopy recovery was uneventful and he was discharged home 24 h later with complete symptom resolution.