foreign body aspiration ( fba ) is one of the most common and lethal problems which accounts for 7% of life threatening accidents in children aged 13 years . however , often it may remain undetected due to atypical history or misleading clinical and radiological findings . delayed diagnosis may occur when parents under appreciate the symptoms or when physicians overlook clinical and radiological findings . the diagnosis and removal of the object become much more difficult in such cases . here , we report a case of bronchiectasis due to long - term retained foreign body left lower lobe lung which was initially thought to be as postpulmonary tuberculosis ( tb ) sequel . a 17-year - old girl was referred to our hospital with chief complaints of recurrent hemoptysis for 1 year with fever off and on . although the history of occasional mild hemoptysis was present for the last 5 years , its frequency gradually increased to as many as 5 times in a month . the patient was referred to our institute from a government medical college hospital for surgery . chest x - ray and contrast - enhanced computed tomography chest confirmed the diagnosis of medial basal segment bronchiectasis of the lower lobe of left lung [ figures 1 and 2 ] . in spite of sputum negative for acid fast bacilli ( afb ) , the patient had been given a full course of antitubercular therapy on daily basis for 6 months 5 years ago . bronchial artery embolization was also done for her persisting symptoms 6 months prior to her referral to our institute . finally , the decision of surgery was taken as there was no improvement in her symptoms . mild to moderate adhesions was found intraoperatively , and finally , left lower lobectomy was performed . histopathological report of the postoperative specimen of the left lower lobe lung revealed foreign body with nonspecific changes . retrograde history from the parents revealed the occurrence of fba ( small piece of plastic whistle ) long back approximately 10 years ago when the patient was about 7 years old . positive history further added to the diagnosis of the left lower lobe bronchiectasis as a complication of long - standing retained foreign body in lung . the postoperative course was uneventful , and the rest of the lung expanded completely [ figure 3 ] . preoperative contrast enhanced computed tomography chest showing left lower lobe lung bronchiectasis postoperative chest x - ray showing expanded left lung zhijun et al . in their therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body found that these foreign bodies were located in the trachea in 75 cases ( 5.25% ) , right bronchial tree in 780 patients ( 54.62% ) , left bronchial tree in 567 cases ( 39.71% ) , and bilateral bronchial tree in six cases ( 0.42% ) . types of foreign body included peanuts ( 1244 cases , 87.12% ) , beans ( 93 cases , 6.51% ) , and others ( 91 cases , 6.37% ) . coughing , choking , acute dyspnea , sudden onset of symptoms , and wheezing are the main features of fba in tracheobronchial tree . sometimes , it can subside spontaneously and quickly even when a foreign body is in situ . of all these signs and symptoms , the most predictive one is witnessed aspiration associated with a choking episode ( penetration syndrome ) . had described that neither clinical signs and symptoms nor radiology hasve sufficient diagnostic sensitivity or specificity , on which one can rely for the diagnosis . only the presence of choking crisis , when elicited in history , has good sensitivity and specificity ( 96% and 76% , respectively ) in their series . fba may lead to airway compromise and death or serious sequels such as bronchiectasis , atelectasis , and recurrent pneumonia . to prevent these complications , prompt diagnosis and removal of foreign body are mandatory . whenever a choking crisis is present in the patient 's history , however , absence of early symptoms and radio - opaque objects should not exclude the possibility of foreign body inhalation . in this case , the reason behind not reaching the correct diagnosis preoperatively was neglecting the importance of detailing the remote history of fba and absence of symptoms as well during aspiration . another reason for incorrect diagnosis was confusing the sequel of fba with that of pulmonary tb . it is the under appreciation of symptoms of choking crisis which leads to retained foreign body . bronchiectasis and all other long - term complications which occur after pulmonary tb can also occur due to retained foreign body lung . hence , the importance of a proper history taking can not be overlooked , and possibility of fba should always be ruled out in such cases before making a diagnosis of pulmonary tb and thus subjecting the patient to long - term and cumbersome antituberculosis therapy unnecessarily .
tracheobronchial foreign body aspiration ( fba ) is a very common and lethal problem among children . 
 it can easily be diagnosed with a typical history of choking crisis . clinical examination and radiology 
 play a secondary role in diagnosis . 
 acute choking episode may lead to death or else to serious sequels such as bronchiectasis , atelectasis , and recurrent pneumonia . here , we report an interesting case of bronchiectasis in a young female initially thought to be a consequence of pulmonary tuberculosis , who was subsequently found to have retained foreign body in the left lower lobe lung which was the actual cause of her symptoms .