Foreign matter aspiration occurs relatively commonly in
drowning and
near-drowning events. In most cases, stomach contents are aspirated.
Sand aspiration rarely occurs and there are no reported cases in children with
near drowning. Limited data are available on clinical presentation and management of
sand aspiration with accidental burial. We report a 3-year-old boy who nearly drowned while swimming in brackish waters and was found face down in
sand.
Sand aspiration was suspected when the child continued to have persistent
wheezing and high ventilatory requirement despite intensive
bronchodilator and
corticosteroids therapy with an inability to wean after 4 days post-
near-drowning event. Radiology was non-specific in the absence of
sand bronchogram. Presence of
sand in the airways was confirmed when a bronchoscopy was undertaken and
sand seen in the bronchoalveolar lavage fluid. Sequential lung washing followed by exogenous
surfactant administration (3 ml/kg) was undertaken and lead to significant improvement such that within 12 hr post-therapeutic lavage, his ventilatory requirements reduced substantially. The child was extubated 4 days post-lavage and on review 2 months post-event, was clinically well with airway resistance within normal predicted values measured on forced oscillatory spirometry (IOS).