This document describes the case of 1 year 4 month old Abu Hanif who presented with cough for 45 days, noisy respiration for 30 days, and excessive salivation. On examination, he appeared sick and had fast breathing and chest indrawing. Initial tests showed normal CBC and chest x-ray. Bronchoscopy revealed a metallic foreign body in the left principal bronchus. The foreign body, a small red bulb, was removed through rigid bronchoscopy. Abu Hanif's symptoms resolved after removal of the foreign body.

1. WELCOME TO CPD
Presented by
Dr. Minhajul Islam
DCH Student
Dept. Of Pediatrics
ICMH, Matuail, Dhaka

2. PARTICULARS OF THE PATIENT
 Name: Abu Hanif
 Age: 1yr 4months
 Sex: Male
• Father’s name: Abdul Motin
• Mother’s name: Roksana Akter
• Address: Titash , Cumilla

3. PARTICULARS OF THE PATIENT
 Date of admission: 26/12/22
 Date of Examination:26/12/22

4. CHIEF COMPLAINTS
1. Cough for 45 days.
2. Noisy respiration for 30 days.
3. Excessive salivation for same duration.

5. H/O PRESENT ILLNESS
According to the statement of informant mother
Abu Hanif was reasonably well 45 days back.
Then he developed cough which was abrupt
onset ,non productive in nature .Cough used to
occur all day long. She also noticed noisy
respiration for 30 days. Mother also complaints
of excessive salivation of her boy for same
duration. abu hanif symptom.mp4

6. H/O PRESENT ILLNESS
Baby had no H/O of any foreign body
aspiration, evening raise of temp, weight loss
or close contact with TB or Covid-19 patient .
With above complaints she took her baby to
different registered physician and was treated
with several antibiotics .

7. H/O PRESENT ILLNESS
Among medications she can mention
Zimax, Cefim3, Tofen syrup name .But no
significant improvement occurs . Then she
came to ICMH with her child for further
evaluation and management.

8. H/O PAST ILLNESS
• No significant illness

9. BIRTH HISTORY
 Mother was on regular antenatal check up.
 Baby was delivered at term at hospital by
LUCS . Birth weight was 2.6 kg.
 His Postnatal period was uneventful .

10. FEEDING HISTORY
• Now he is on breast feeding along with
family food.

11. DEVELOPMENTAL HISTORY
• Age appropriate.

12. IMMUNIZATION HISTORY
• Immunization ongoing as per EPI
schedule

13. FAMILY HISTORY
 4th issue of non-consanguineous parents.
 No family h/o asthma.

14. SOCIO-ECONOMIC HISTORY
 Father: Farmer
 Mother: House wife
 Housing: Tin-shed Paka
 Sanitation: Sanitary latrine
 Drinks: Tube well water

15. GENERAL EXAMINATION
 Appearance: Sick looking
 Anemia: Absent
 Jaundice: Absent
 Cyanosis: Absent
 Oedema: Absent
 Dehydration: Absent

16. GENERAL EXAMINATION
 Clubbing: Absent
 Koilonychia: Absent
 Pulse: 114 beats/min:
 R/R: 45 breaths/min
 Temperature: 980 F
 Lymph node: Not palpable

17. GENERAL EXAMINATION
 Thyroid gland: Not enlarged
 Skin Survey: Normal
 Sign of meningeal irritation: Absent

18. ANTHROPOMETRY
Observed 50th
Centile
5th
Centile
Z score
Weight for Age Z
score
10.5kg 11.3kg 9.5kg -0.80
Weight for
Length Z score
10.5kg 12.3kg 10kg -1.41
Length for Age Z
score
87cm 80cm 75cm +2.52
OFC 46.5cm 47.4cm 45.2cm -0.74

19. RESPIRATORY SYSTEM
INSPECTION:
 Respiratory Rate 45 breaths/min
 Supra sternal recession and chest indrawing present
 No chest deformity
PALPATION:
 Trachea centrally placed
 Chest movement symmetrical on both sides.
PURCUSSION:
 Resonance in both side
 Vocal fremitus normal
AUSCULTATION:
 Breath sound vesicular on both side ,no added sound.
 Vocal resonance normal

20. OTHER SYSTEM
• Other systemic examination revealed no
abnormality.

21. SALIENT FEATURES
Abu Hanif, 1yr 4 months, 10.5 kg, 4th issue of
non-consanguineous parents , immunization on
going , son of a farmer came from Cumilla
admitted on 26/12/22 with the complaints of
cough for 45 days, noisy respiration for 30 days
and excessive salivation for same duration. He
was treated by different physician with antibiotics.

22. SALIENT FEATURES CONT’D
But no improvement occurs. Then he came to
ICMH for further evaluation and management.
On examination he was sick looking,
coughing, HR 114 b/min RR 45/min, trachea
was centrally placed , supra sternal recession
and chest indrawing present and breath sound
was vesicular, there was no added sound.
Other systemic examination was normal.

23. PROVISIONAL DIAGNOSIS
• Persistent Pneumonia

24. PERSISTENT PNEUMONIA
POINTS IN FAVOR POINTS AGAINST
Persistent cough for 45
days
No H/O Fever
On Examination fast
breathing , supra sternal
recession , chest indrawing
preset
Breath sound was vesicular
without added sound

25. DIFFERENTIAL DIAGNOSIS
 Foreign body aspiration
 Tuberculosis

26. FOREIGN BODY ASPIRATION
POINTS IN FAVOR POINTS AGAINST
1.Age of patient No H/O FB aspiration
2.Male
3.H/O abrupt onset
cough , noisy
respiration and
salivation.

27. TUBERCULOSIS
POINTS IN FAVOR POINTS AGAINST
Persistent cough for 45
days not responding to
conventional antibiotics
No documented weight
loss
Endemic zone No contact with TB patient
No documented fever
Activity was good

28. INVESTIGATIONS
Investigation Investigation Result Reference value
CBC
Haemoglobin 13.2gm/dl 13-17gm/dl
ESR 10 mm 0-10 mm in 1st hr
Total WBC 13310/cumm 4000-
11000/cumm
Neutrophils 18% 25-66%
Lympohocyte 61% 25-62%
Monocyte 07% 02-07%
Eosinophils 14% 00-03%
Total RBC 5.52mill/cumm 3.5-6.2mill/cumm

29. INVESTIGATIONS
GENEXPERT TEST:
 Sample : Induced Sputum
 Result : MTB not Detected

30. INVESTIGATIONS

31. INVESTIGATIONS
investigations results Reference
value
Bleeding Time 2min50sec 2-7min
Clotting Time 3min20sec 6-9min
Blood grouping
& Rh typing
ABO: A
Rh: +ve
RT PCR for
COVID 19
Negative
HBsAg Negative

32. INVESTIGATIONS
• abu hanif
bronchoscopy.mp
4

33. INVESTIGATIONS
BRONCHOSCOPY
 COMMENTS: Impacted coiled metallic foreign
body at distal portion on the wall of left
principal bronchus
 RECOMMENDATION: Removal of foreign body
by rigid bronchoscopy

34. CT SCAN

35. FINAL DIAGNOSIS
• Foreign body aspiration in left principal
bronchus

36. MANAGEMENT
• Diet- Breast feeding & Family food
• Syp Amoxicillin
• Syp Chlorpheniramine maleate
• Counseling
• Child was referred to NIDCH for removal of the
foreign body.

37. MANAGEMENT
• Finally, a FB was removed from left principal
bronchus at NIDCH by rigid bronchoscopy.
• It was a small red bulb of toys.

38. FOREIGN BODY REMOVED
FROM BRONCHUS

39. Master Abu Hanif
BEFORE REMOVAL OF
FOREIGN BODY
AFTER REMOVAL OF
FOREIGN BODY

40. BRONCHOSCOPY TEAM

41. THANK YOU