A 2-year-old child develops sudden onset choking, coughing and unilateral wheeze. Chest X-ray shows hyperinflation of the right lung. The most appropriate next step is:

• A CT thorax to confirm foreign body location
• B Emergency Heimlich manoeuvre followed by observation
• C Rigid bronchoscopy under general anaesthesia ✓
• D Flexible bronchoscopy to retrieve the foreign body

Explanation

Unilateral hyperinflation on chest X-ray in a toddler with choking history indicates a ball-valve bronchial foreign body (most commonly the right main bronchus). Rigid bronchoscopy under general anaesthesia allows both definitive diagnosis and controlled retrieval under direct vision and is the gold standard. Flexible bronchoscopy lacks the working channel diameter and suction capacity needed for safe retrieval in young children. CT is not necessary and delays definitive treatment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.