A 3-year-old with abrupt onset focal wheezing localized to the right lower lobe; most likely diagnosis?

A 3-year-old with abrupt onset focal wheezing localized to the right lower lobe; most likely diagnosis?

• A. Asthma
• B. Foreign Body Aspiration
• C. Epiglottitis
• D. Bronchiectasis

Answer: (B)

Abrupt unilateral wheezing in a preschooler points to obstruction of a single airway by a foreign body. Small children frequently aspirate objects during meals or play, and when the object partially blocks a bronchus it causes wheezing and decreased breath sounds in the affected area, often localized to the right lower lobe because the right mainstem bronchus is more vertical and accessible in kids. Radiographs can show air trapping or atelectasis in the involved lung, though the object itself may be radiolucent, so a normal film does not rule out aspiration. In contrast, asthma typically produces diffuse wheeze; epiglottitis presents with drooling and severe upper airway symptoms, not focal wheeze; bronchiectasis is a chronic condition with recurrent infections, not an abrupt unilateral wheeze. If suspicion remains high, bronchoscopy is used to confirm and remove the object.

Abrupt unilateral wheezing in a preschooler points to obstruction of a single airway by a foreign body. Small children frequently aspirate objects during meals or play, and when the object partially blocks a bronchus it causes wheezing and decreased breath sounds in the affected area, often localized to the right lower lobe because the right mainstem bronchus is more vertical and accessible in kids. Radiographs can show air trapping or atelectasis in the involved lung, though the object itself may be radiolucent, so a normal film does not rule out aspiration. In contrast, asthma typically produces diffuse wheeze; epiglottitis presents with drooling and severe upper airway symptoms, not focal wheeze; bronchiectasis is a chronic condition with recurrent infections, not an abrupt unilateral wheeze. If suspicion remains high, bronchoscopy is used to confirm and remove the object.