A 2-year-old child suddenly develops choking, coughing and unilateral wheeze after playing with small toys. Chest X-ray shows hyperinflation of the right lung. The most appropriate next step is:
- A Flexible bronchoscopy under sedation
- B CT chest to locate the foreign body before intervention
- C Immediate rigid bronchoscopy under general anaesthesia ✓
- D Back blows and chest thrusts followed by observation
Correct answer: C. Immediate rigid bronchoscopy under general anaesthesia
Explanation
Unilateral air trapping on chest X-ray following sudden choking in a toddler indicates a distal bronchial foreign body acting as a ball valve. Rigid bronchoscopy under general anaesthesia is the gold-standard treatment, allowing direct visualisation, controlled ventilation, and removal with optical forceps. Flexible bronchoscopy lacks the instrumentation for reliable foreign body removal in children. CT may delay definitive treatment. Back blows are appropriate first aid only in acute complete airway obstruction.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.