Visual Diagnosis: An Unusual Cause of Chronic Cough in an Adolescent

Samira Naime; Damian Maxwell; Kevin Maupin

doi:10.1542/pir.2016-0029

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Samira Naime, MD*
Damian Maxwell, MD^†
Kevin Maupin, MD^‡

Departments of ^*Pediatrics and
^†Pediatric Surgery, Charleston Area Medical Center, Charleston, WV
^‡Pediatric Pulmonology, West Virginia University Health Sciences Center, Charleston Division, Charleston, WV

AUTHOR DISCLOSURE
Drs Naime, Maxwell, and Maupin have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 17-year-old boy with a history of asthma, Hirschsprung disease, scoliosis, and an extensive neurologic history that includes cerebral palsy presents with dysphagia to liquid. The patient has a new recurrent cough with the ingestion of liquids that started 3 months before presentation to the pulmonary clinic. He has no documented previous history of choking with eating or drinking. He has no fever, respiratory distress, or history of recurrent pneumonia. The patient has a significant history of surgeries, including spinal fusion 5 years before the onset of the current symptoms. He also had a ventriculoperitoneal shunt insertion with multiple revisions, the last occurring 1 year ago. There is no record of prolonged intubation after the patient’s surgeries. Physical examination during this visit shows a comfortable boy with no signs of acute distress, and lung examination reveals no audible wheezing or crackles.

A modified barium swallow study shows a …