The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Whistling Cough
A B

A
Suresh C. Sharma, M.S. 4-year-old boy presented to the otorhinolaryngology out-
Pirabu Sakthivel, D.N.B., M.Ch. patient clinic with a 2-day history of persistent cough that had an intermit-
All India Institute of Medical Sciences tent whistling character (see video). The patient had no history or symp-
New Delhi, India toms of viral infection of the upper respiratory tract, and he otherwise felt well. His
pirabusakthivel@gmail.com parents reported that he had been playing with a whistle before the onset of his
coughing. Physical examination was notable for an expiratory wheeze in the middle
and lower left lung. The remainder of the physical examination was unremarkable.
A video of a Radiography of the chest revealed hyperinflation of the left lung (Panel A). Al-
“whistling cough” though a foreign body could not be definitively identified, air trapping in expira-
is available at
tory radiographs can suggest the presence of an aspirated foreign body in the
NEJM.org
bronchus, since air can enter the bronchus around the foreign body but cannot
exit. A rigid bronchoscopy was performed, given the likelihood that a foreign body
had lodged in the lung. A toy whistle (Panel B), which had been obstructing the left
segmental bronchus, was retrieved. A repeat chest radiograph, obtained the day after
retrieval of the foreign body, showed resolution of the hyperinflation. The child
remained well at a 1-year follow-up visit.
DOI: 10.1056/NEJMicm1716704
Copyright © 2018 Massachusetts Medical Society.

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