Pediatr. praxi. 2026;27(1):48-51 | DOI: 10.36290/ped.2026.008

Unexpected finding in the airways of a child with cystic fibrosis

MUDr. Anna Šmejkalová¹, doc. MUDr. Václav Koucký, Ph.D.¹, MUDr. Jana Bartošová¹, MUDr. Hana Hrdinová², prof. MUDr. Jan Baxa, Ph.D.³, MUDr. Marcela Kreslová, Ph.D.⁴

¹ Pediatrická klinika, 2. lékařská fakulta a Fakultní nemocnice v Motole, Univerzita Karlova, Praha

² Klinika zobrazovacích metod, 2. lékařská fakulta a Fakultní nemocnice v Motole, Univerzita Karlova, Praha

³ Klinika zobrazovacích metod, Lékařská fakulta v Plzni, Univerzita Karlova, Fakultní nemocnice Plzeň

⁴ Dětská klinika, Univerzita Karlova, Lékařská fakulta v Plzni, Fakultní nemocnice Plzeň

We present a case report of an unusual cause of lower airway obstruction in a four-year-old boy with severe cystic fibrosis (CF), genotype F508del/F508del, chronically infected with Pseudomonas aeruginosa and dependent on percutaneous endoscopic gastrostomy (PEG) for long-term failure to thrive. The patient, with psychomotor delay and profound psychosocial deprivation associated with institutional care, was acutely hospitalized for vomiting, dehydration, and weight loss. Chest computed tomography revealed left lower lobe atelectasis suspicious for necrotizing pneumonia, along with significant atelectatic and infiltrative changes in the right lower lobe. Due to insufficient response to conservative therapy, bronchoscopy was performed, revealing obstruction of the left lower lobe bronchus by a thick, stercoraceous, foul-smelling mass. The finding was consistent with fecal aspiration related to an eating disorder (pica). Restoration of airway patency required repeated bronchoscopic interventions, including cryoprobe-assisted removal. Following obstruction clearance, there was a marked clinical improvement, normalization of lung auscultation findings, and subsequent resumption of oral intake with a positive weight curve trend. This case highlights the importance of a comprehensive differential diagnostic approach to airway obstruction in children, particularly those with chronic pulmonary disease and concurrent neurodevelopmental delay in the context of adverse psychosocial environments. Although fecal aspiration is an extremely rare cause of bronchial obstruction, it should be considered in patients with eating disorders such as pica or with recurrent vomiting. Timely bronchoscopic intervention is crucial for both diagnosis and effective management and may significantly contribute to the prevention of irreversible lung damage.

Keywords: cystic fibrosis, stercoral bronchitis, bronchoscopy, pica, aspiration, airway obstruction.

Accepted: February 16, 2026; Published: March 3, 2026  Show citation