An 11-month-old infant with laryngeal and pharyngeal injuries due to aspiration of an L-shaped metal fragment: A case report

Airway foreign bodies require urgent removal owing to their life-threatening risks. Symptoms such as coughing and wheezing typically appear immediately after aspiration, although symptom improvement can delay diagnosis and treatment. This report describes a rare case of aspiration of an L-shaped metal fragment that injured the larynx and pharynx. The patient was an 11-month-old girl who developed a persistent cough while eating baby food. Her primary care physician initial discharged her with mild hoarseness, but persistent hoarseness led to an emergency room visit. Although her vital signs were stable, crying revealed hoarseness and inspiratory wheezing. Suspecting an airway foreign body, a chest X-ray revealed a metal object in the neck. Computed tomography showed that the fragment's edges were in the larynx and pharynx, spanning the arytenoid cartilages. The pharyngeal end of the fragment had punctured the posterior pharyngeal wall, and submucosal free air was observed. The foreign body—a thin and 2-cm-long L-shaped metal fragment—was removed under intravenous anesthesia using video laryngoscopy. Owing to the risks of emphysema, hematoma, and edema from inflammation of the posterior pharyngeal wall, the patient was intubated for 3 days and recovered well. As demonstrated, aspiration of irregularly shaped foreign objects can cause severe injury to surrounding structures. Careful diagnostic attention is crucial, and for suspected emphysematous lesions in the pharynx or mediastinum, endotracheal intubation and ventilatory support should be considered.