The Diagnostic Challenge of Sharp Foreign Body Aspiration in Children: A Two-Case Series Highlighting Ingestion vs. Aspiration.

Foreign body aspiration (FBA) is a common pediatric emergency. Sharp objects, such as pins, pose a unique risk of perforation and migration. Differentiating aspiration from ingestion can be challenging when symptoms and radiological findings overlap, particularly for objects lodged in the mediastinum-a "mediastinal dilemma." We present two cases of sharp FBA in school-aged children. Case 1: A 10-year-old girl presented with acute chest pain after inhaling a headscarf pin. Chest X-ray showed a mediastinal radio-opaque shadow, creating a diagnostic dilemma. Sequential endoscopy (negative esophagoscopy followed by rigid bronchoscopy) confirmed and removed the pin from the left main bronchus. Case 2: A 14-year-old boy presented with delayed hemoptysis 2 months after aspirating a sewing needle. Initial rigid bronchoscopy was unsuccessful, necessitating flexible bronchoscopy for retrieval from the peripheral left upper lobe. These cases highlight that sharp FBA can occur in older children and may present with atypical, delayed symptoms. The mediastinal location on radiography often blurs the line between aspiration and ingestion. A high index of suspicion is paramount. The choice of endoscopic technique (rigid vs. flexible) must be tailored to the foreign body's location and nature. This series underscores the need for heightened awareness of this preventable hazard, particularly regarding the risk of holding objects between the lips.