Foreign body causing 'whistling' cough: NEJM case report
A 4-year-old boy presented to the otorhinolaryngology outpatient clinic with a 2-day history of persistent cough that had an intermittent whistling character (see video). The patient had no history or symptoms of viral infection of the upper respiratory tract, and he otherwise felt well. His parents reported that he had been playing with a whistle before the onset of his coughing.

Physical examination was notable for an expiratory wheeze in the middle and lower left lung. The remainder of the physical examination was unremarkable. Radiography of the chest revealed hyperinflation of the left lung (Panel A). Although a foreign body could not be definitively identified, air trapping in expiratory radiographs can suggest the presence of an aspirated foreign body in the bronchus, since air can enter the bronchus around the foreign body but cannot exit.

A rigid bronchoscopy was performed, given the likelihood that a foreign body had lodged in the lung. A toy whistle (Panel B), which had been obstructing the left segmental bronchus, was retrieved. A repeat chest radiograph obtained the day after retrieval of the foreign body, showed resolution of the hyperinflation. The child remained well at a 1-year follow-up visit.

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