Wheezing differential diagnosis
Foreign body aspiration is included in the differential diagnosis of wheezing with a variety of congenital and acquired conditions.[11] Table 1 presents the alternative diagnosis of acute and recurrent or chronic wheezing.

Table 1

A.

B.

References

1. From the Centers for Disease Control and Prevention. Nonfatal choking-related episodes among children--United States, 2001. Jama, 2002. 288(19): p. 2400-2.
2. Mu, L., P. He, and D. Sun, Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope, 1991. 101(6 Pt 1): p. 657-60.
3. Schmidt, H. and B.C. Manegold, Foreign body aspiration in children. Surg Endosc, 2000. 14(7): p. 644-8.
4. Ciftci, A.O., et al., Bronchoscopy for evaluation of foreign body aspiration in children. J Pediatr Surg, 2003. 38(8): p. 1170-6.
5. Eren, S., et al., Foreign body aspiration in children: experience of 1160 cases. Ann Trop Paediatr, 2003. 23(1): p. 31-7.
6. Lea, E., et al., Diagnostic evaluation of foreign body aspiration in children: aprospective study. J Pediatr Surg, 2005. 40(7): p. 1122-7.
7. Tan, H.K., et al., Airway foreign bodies (FB): a 10-year review. Int J Pediatr Otorhinolaryngol, 2000. 56(2): p. 91-9.
8. Blazer, S., Y. Naveh, and A. Friedman, Foreign body in the airway. A review of 200 cases. Am J Dis Child, 1980. 134(1): p. 68-71.
9. Mu, L.C., D.Q. Sun, and P. He, Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases. J Laryngol Otol, 1990. 104(10): p. 778-82.
10. Black, R.E., D.G. Johnson, and M.E. Matlak, Bronchoscopic removal of aspirated foreign bodies in children. J Pediatr Surg, 1994. 29(5): p. 682-4.
11. Martinati, L.C. and A.L. Boner, Clinical diagnosis of wheezing in early childhood. Allergy, 1995. 50(9): p. 701-10.

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Allergy field concerned and key words: foreign body aspiration, wheezing, respiratory distress, stridor, asthma, differential diagnosis

Summary
We describe a case of a 7-year-old girl with recurrent episodes of severe respiratory distress associated with wheezing and/or stridor for the past 7 months. The girl suffered from wheezing episodes and cough in association with acute viral upper respiratory infections for the last 3 years. These clinical manifestations usually coincided with the episodes of respiratory distress and delayed the diagnosis of a foreign body aspiration (FBA) for more than 7 months. Most important factors responsible for the diagnostic delay included the mild symptoms with which the unwitnessed aspiration of foreign body was associated, the aforementioned wheezing episodes and the misinterpretation of symptoms.

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