Flexible Bronchoscopic Retrieval of an Aspirated Toy Whistle Using a Modified 4 Fr Fogarty Balloon Technique

Foreign body aspiration in children is an important cause of airway morbidity and may present with persistent cough, delayed diagnosis, atelectasis, and granulation tissue formation. Smooth hollow plastic foreign bodies may be particularly difficult to retrieve because standard forceps often fail to achieve a secure grip, and balloon-assisted techniques may be limited by repeated slippage. We report the case of a seven-year-old boy who presented with a persistent cough for 15 days following aspiration of a toy whistle. He was referred to our center after an unsuccessful retrieval attempt at another hospital in South India. Chest radiography at our institution demonstrated left lung volume loss with compensatory contralateral hyperinflation, while computed tomography performed at the referring center demonstrated an endobronchial foreign body in the left main bronchus with lingular atelectasis. Flexible bronchoscopy was selected as a staged minimally invasive approach with rigid bronchoscopy backup immediately available. The procedure was performed under general anesthesia through a laryngeal mask airway using a Fujifilm EB-710P slim bronchoscope (Fujifilm, Tokyo, Japan) with a 2.2 mm working channel. During the initial bronchoscopy session, multiple whistle fragments were removed using alligator and rat-tooth forceps; however, a retained hollow cylindrical component could not be extracted because granulation tissue and retained secretions limited visualization. Nebulized budesonide was administered between procedures as part of institutional clinical practice to reduce airway inflammation and improve visualization, and repeat bronchoscopy was performed the following day. During the second session, a 4 Fr Fogarty balloon catheter was advanced distal to the retained component. Balloon inflation with air repeatedly failed because of slippage within the smooth lumen, whereas inflation with 0.5 mL saline achieved improved anchorage and enabled successful extraction. Follow-up imaging demonstrated complete lung re-expansion. This case highlights the importance of individualized procedural planning and a staged bronchoscopic approach in technically difficult pediatric airway foreign bodies. Saline inflation of a Fogarty balloon catheter may represent a practical troubleshooting modification in selected hollow airway foreign bodies when conventional retrieval techniques fail.