A 2-year-old child is brought with sudden onset choking, coughing, and progressive wheeze. Chest X-ray shows hyperinflation of the right lung with mediastinal shift to the left. The most likely diagnosis and immediate intervention is:
- A Right pneumothorax — chest drain insertion
- B Right main bronchus foreign body causing ball-valve obstruction — rigid bronchoscopy ✓
- C Right lobar pneumonia — antibiotics and physiotherapy
- D Right diaphragmatic hernia — urgent surgical repair
Correct answer: B. Right main bronchus foreign body causing ball-valve obstruction — rigid bronchoscopy
Explanation
Unilateral hyperinflation with contralateral mediastinal shift after acute choking in a toddler is pathognomonic of an endobronchial foreign body causing a ball-valve (check-valve) mechanism — air enters during inspiration but cannot exit on expiration, trapping air distally. Rigid bronchoscopy under general anesthesia is the definitive diagnostic and therapeutic procedure. This differentiates it from pneumothorax (which causes ipsilateral collapse with mediastinal shift away) and pneumonia.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.