Foreign body aspiration presenting as life-threatening bronchial asthma

A two-year-old male, a known case of bronchial asthma was admitted as a case of exacerbation of asthma. He did not improve with standard treatment and required invasive ventilator support twice during his admission. The chest x-rays only showed hyperinflation but CT scan of the thorax revealed a foreign body [a piece of Betel nut] lodged in the right main bronchus. It was removed under bronchoscopic guidance. A foreign body may not be radio-opaque and therefore may not be visible in chest x-ray. The possibility of foreign body aspiration should always be considered in children presenting with an exacerbation of bronchial asthma