Pediatric push pin aspiration: clinical, radiologic, and pathologic correlation — case report

Abstract

Background: Aspiration of foreign bodies is not uncommon in the pediatric setting, and the consideration and recognition of an aspiration event are vital to prompt management. Pointed and sharp-edged foreign bodies have the potential to lodge in the airway and increase the difficulty of identification and removal. Here, we describe a fatal aspiration of a push pin that was unrecognized prior to death. Methods: Review of police and medical records was completed prior to postmortem CT imaging and full pediatric autopsy with high resolution photography. Case presentation: A 15-month-old boy was playing at home when he acutely vomited and then became unresponsive. Paramedic and hospital physicians performed pediatric CPR protocols, including intubation, without success. Postmortem radiographic imaging revealed a metallic foreign body at the level of the larynx. Autopsy demonstrated a push pin fully occluding the trachea at the level of the vocal cords. Conclusions: The diagnosis of aspirated FBs may be elusive, and clinicians and autopsy pathologists ought to be mindful that children with FBs may have atypical presentations. Use of postmortem radiologic imaging can assist in the diagnosis and allow for a targeted autopsy approach to best visualize the offending foreign body.