Hidden dangers of vegetative foreign body aspiration in children: case report and literature review

Abstract

Foreign body aspiration (FBA) is a common pediatric emergency; however, vegetative foreign bodies, particularly inflorescences, pose a unique diagnostic challenge due to their potential for extra-airway migration. This report describes a rare case of wheat-spike aspiration in a child and highlights the associated diagnostic difficulties. An 11-year-old boy presented 48 hours after inhaling a wheat spike, with left-sided chest pain and mild dyspnea. Initial chest radiography was unremarkable. Due to persistent symptoms, flexible bronchoscopy was performed on day five but did not reveal any foreign body; the procedure was complicated by a complete left pneumothorax requiring chest tube drainage. Approximately 15 days after the incident, the patient developed high fever and a painful, fluctuant swelling on the left posterolateral chest wall. Laboratory findings indicated significant inflammation. Repeat chest radiographs demonstrated new consolidation in the left lower lobe. Chest computed tomography (CT) revealed a soft-tissue abscess containing a linear foreign body consistent with a wheat spike. Surgical drainage via a limited incision yielded purulent fluid, and the wheat spike was successfully retrieved intact. Pus cultures grew “Escherichia coli”. The patient showed rapid clinical improvement following surgical intervention and targeted antibiotic therapy. At 12-month follow-up, he remained asymptomatic with no evidence of recurrence. This case illustrates the diagnostic complexity of vegetative foreign body aspiration. Normal early imaging or negative bronchoscopy does not exclude extra-airway migration. Persistent or evolving symptoms following plant-based aspiration should prompt repeat evaluation and early CT imaging.