A previously healthy 18-month-old girl presented to a local hospital with a 2-day history of dry cough, hoarse voice and difficulty breathing. There was no history of aspiration. Despite therapy with nebulized budesonide (4 mg/d, twice daily) and oral dextromethorphan syrup (1 mg/kg/d, twice daily) for 2 days for presumed croup, the patient's respiratory status did not improve and she was referred to our institution. Stable vital signs, biphasic stridor, increased work of breathing and intercostal retractions (for a video, see Appendix 1 at www.cmaj.ca/lookup/doi/10.1503/cmaj. 220544/tab-related-content) prompted further investigations for a foreign body. Computed tomography of her neck and chest showed normal findings. On day 2, a flexible bronchoscopy examination found a thin, sharp shell of a sunflower seed embedded in the patient's subglottic airway, which was removed with a grasping basket (Figure 1A and 1B). We discharged her on day 6 with complete, uneventful recovery.
Foreign body aspiration accounts for 7% of accidental deaths...