A 5-year-old girl presented with episodes of coughing, inspiratory stridor, and occasionally squeaking breath sounds. There was no history of a foreign body aspiration. Initially, she was diagnosed with allergic asthma. However, signs and symptoms continued despite a trial of inhaled corticosteroids. A chest radiograph showed a hyperlucent right lung, mainly in the upper lobe, with decreased vascular markings compatible with Swyer-James-MacLeod syndrome, or foreign body aspiration. V/Q imaging showed markedly diminished right lung ventilation and perfusion, especially in the upper lobe, with a hot spot in the area of the right bronchus. At bronchoscopy, a pistachio nutshell was removed from the right main bronchus.
From the Departments of *Nuclear Medicine and †Radiology, Medical Center Leeuwarden, Leeuwarden; and ‡Department of Otorhinolaryngology and §Department of Pediatric Pulmonology and Allergology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands.
Received for publication January 2, 2012; revision accepted March 27, 2012.
Conflicts of interest and sources of funding: none declared.
Reprints: Hans Balink, MD, Medical Center Leeuwarden, 8901 BR Leeuwarden, the Netherlands. E-mail: firstname.lastname@example.org.