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Respiratory Medicine Case Reports
journal homepage: www.elsevier.com/locate/rmcr
Case report
When Christmas decoration goes hand in hand with bronchial aspiration …
Ania Carsin, Mélisande Baravalle-Einaudi, Jean-Christophe Dubus∗
Pediatric Pulmonology, University Hospital Timone-Enfants, Aix-Marseille University, Marseille, France
A R T I C L E I N F O
Keywords:
Child
Foreign body aspiration
Domestic injury
A B S T R A C T
We report the case of a 14-month-old girl suffering from cough and wheeze around Christmas. She was treated
with anti-asthmatic drugs with no success, and 3 weeks later a chest X-ray revealed a LED bulb in the left main
bronchus. This LED bulb came from a Christmas light garland decorating the Christmas tree. We discuss the
different Christmas objects that can be inhaled by young children, the challenge to diagnose bronchial inhalation
during this winter period, and the emergence of new foreign bodies, such as LED bulbs, with a particularly
aerodynamic shape.
« Oh, when I hear the Christmas tunes, I like to look back to my
childhood joys … ». We are not absolutely sure that this young, 14month-old
girl will be in the same spirit in the coming years … Indeed,
two days before Christmas she developed a cough and wheeze. There
was no cyanosis nor suffocation syndrome. Her general practitioner
found bilateral wheezing with no respiratory distress, and due to a past
history of wheezing she was treated with inhaled salbutamol and oral
prednisolone. Three weeks later her clinical status had not improved
and a chest X-ray was performed. A U-shaped radiopaque foreign body
was localized in the left main bronchus (Fig. 1). A light-emitting diode
(LED) bulb was successfully removed by rigid bronchoscopy under
general anesthesia (Fig. 2). To note, several attempts were necessary
because the anode and/or cathode penetrated the bronchial mucosa
during the removal procedure. The patient was symptom free after the
LED removal. Finally, the parents reported a missing LED bulb on the
Christmas light garland decorating the Christmas tree.
To diagnose a foreign body in the respiratory tract at the Christmas
period in a young child may be a challenge. Nearly all children are sick
during this period. Acute viral bronchiolitis and other winter upper and
lower wheezy respiratory diseases are so frequent that a misdiagnosis
may be easy, particularly when a suffocation episode is absent. For the
little that there is a history of wheezing, as in our case report, an antiasthmatic
treatment is wrongly prescribed. Therefore the “Christmas
bronchial aspiration” should be of particular knowledge, because the
imagination of our children for inhaling objects, including Christmas
decorations, is limitless. For instance, inhalation of plastic Christmas
bow pins have resulted in several deaths in the past, obliging the 3M
Company to modify the circular base of the bow pin into the form of a
cross to decrease the risk of aspiration asphyxia with an object that does
not completely obstruct the airway [1]. More recently, a flat plastic
Christmas tree embedded within granulomatous cords causing almost
complete airway obstruction, and requiring tracheostomy before extraction,
has been removed 2 years after the inhalation [2]. The occurrence
of new technologies for Christmas decorations, such as LED
bulbs, with an aerodynamic design facilitating the bronchial penetration
despite its size, lead to new respiratory foreign bodies for whom
extraction is not always easy. To our knowledge, only another Chinese
case report [3] of a 15-month-old girl with a LED bulb in the right main
Fig. 1. Chest X-ray of a 14-month-old girl showing a U-shaped radiopaque foreign body
into the left main bronchus.
http://dx.doi.org/10.1016/j.rmcr.2017.09.011
Received 30 June 2017; Accepted 28 September 2017
∗
Corresponding author. Pediatric Pulmonology, University Hospital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France.
E-mail address: jean-christophe.dubus@ap-hm.fr (J.-C. Dubus).
Respiratory Medicine Case Reports 22 (2017) 266–267
2213-0071/ © 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
MARK
bronchus has been reported, but monitoring such cases may be of interest
to possibly reconsider the shape of some LED bulbs.
Conflict of interest
None.
Acknowledgements
Thank you to Mrs Robbins for her English review of the manuscript.
References
[1] L.G. Siegel, H.V. Mendenhall, S.L. Liston, Christmas bow pins: a potential inhaled
foreign body made safer by industrial modifications, South Med. J. 74 (1981) 17–20.
[2] J. Philip, M. Bresnihan, N. Chambers, A Christmas tree in the larynx, Pediatr.
Anaesth. 14 (2004) 1016–1020, http://dx.doi.org/10.1111/j.1460-9592.2004.
01510.
[3] C.T. Lau, L. Lan, K. Wong, P.K. Tam, A light bulb moment: an unusual cause of
foreign body aspiration in children, BMJ Case Rep. (2015), http://dx.doi.org/10.
1136/bcr-2015-211452 bcr 2015211452.
Fig. 2. The LED bulb from the Christmas light garland decorating the Christmas tree
removed from the left main bronchus.
A. Carsin et al. Respiratory Medicine Case Reports 22 (2017) 266–267
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