Case Studies

Case of Two Pathologies: Incidental Contralateral Endobronchial Foreign Body Discovered During Bronchoscopic Evaluation of a Left Upper Lobe Cavitary Lesion

An 80-year-old male presented with cough for one month, initially productive but later non-productive, with worsening symptoms over the preceding seven days. He also reported intermittent fever for one week. A CT scan of the chest performed at an outside center one month earlier showed a cavitary lesion in the left upper lobe.

A repeat chest radiograph was obtained, followed by flexible bronchoscopy for further evaluation. Bronchoscopy demonstrated purulent secretions arising from the left upper lobe, which were aspirated. In addition, an unexpected foreign body-like object surrounded by thick mucoid secretions was identified in the right main bronchus.

The patient subsequently underwent flexible bronchoscopy under general anesthesia for therapeutic foreign body removal. The foreign body was successfully dislodged using a Fogarty balloon catheter and retrieved with a Dormia basket. Bronchoalveolar lavage (BAL) samples were collected, and microbiological analysis is awaited.

It was quite a challenge removing nearly 2 cm foreign body through the subglottic area.

The extracted foreign body was identified as a betel nut (areca nut).

Foreign body aspiration is not uncommon in the elderly and may remain unrecognized because its symptoms are often masked by coexisting pulmonary diseases. This underscores the importance of considering occult foreign body aspiration as a potential coexisting diagnosis in elderly patients with persistent respiratory symptoms.