A history of recurrent wheezing can delay the diagnosis of foreign body aspiration in a paediatric emergency department

Foreign body aspiration (FBA) into the airways is a potentially life-threatening event, and more frequent in children younger than 3 years of age; it can mimic other diseases by its frequently non-specific clinical and radiological presentation. The commonest misdiagnoses in children are asthma and recurrent respiratory tract infections with wheezing. This often makes it particularly difficult for a timely and proper diagnosis, especially when there is a silent history of FBA (not a rare occurrence in the age group at highest risk). We report a case of a 2-year-old boy who arrived at the emergency department at the Hospital of Ferrara, with dyspnoea, fever and wheezing, which had started 12 h after aspiration of a pistachio. The asymptomatic period after the pistachio aspiration, a history of recurrent wheezing during respiratory infections and the non-specificity of clinical and radiological findings, delayed the right diagnosis of FBA.