Abstract Introduction Foreign body aspiration is uncommon and easily overlooked when no history directly reveals this. Chronically retained objects in the airways can mimic many pathologies, often masquerading as atypical infections or broncholithiasis resulting in misdiagnosis. We present a case of recurrent pneumonia due to an occult aspirated tooth that remained undiagnosed until removal. Case Presentation A 71-year-old man with a history of COPD and 29-year history of recurrent right lower pneumonia presented with progressive dyspnea and right sided chest pain. Over the preceding decades, he was being treated for bacterial pneumonia twice yearly with adequate symptom resolution. Extensive evaluation was completed and negative for immunodeficiency and dysphagia. He was first referred 15 years prior, where CT imaging was notable for right lower opacities with right lower lobar endobronchial lesion. Subsequent flexible bronchoscopy showed an embedded white foreign body presumed to be a broncholith. Patient declined surgical intervention at the time. Continued symptoms and a right lower lobe mass-like consolidation led to another bronchoscopy 5 years prior to presentation which again demonstrated the embedded broncholith and bronchial brushing cultures grew Actinomyces; which was adequately treated. Due to continued infections and progressive dyspnea, he was referred to a tertiary care center for further evaluation. He underwent successful removal of the lesion via rigid bronchoscopy, at which point the ‘broncholith’ was found to be an intact tooth with attached mandibular bone fragment. Further detailed history obtained from the patient’s family post-procedure revealed a history of a motor vehicle crash with complex facial fractures occurring 30 years prior. Since removal, the patient has been doing well with no recurrent infections or hospitalizations. Discussion This case highlights the diagnostic challenge of occult foreign body aspiration, particularly in settings of remote trauma or patients with poor recollection of the event. Retention of a chronic inhaled foreign body can precipitate cough, hemoptysis, bronchiectasis, and recurrent pneumonias mimicking atypical pulmonary infections or broncholithiasis. As noted in this case, Actinomyces may be a colonizer of broncholiths or foreign bodies, infection may also mimic a neoplastic lesion on imaging, further complicating diagnosis. Rigid bronchoscopy can be useful in these cases to facilitate removal of larger or embedded foreign objects while maintaining improved control over bleeding risk. A high index of suspicion and a proactive multidisciplinary approach is necessary to identify endobronchial foreign bodies and enable early removal in symptomatic patients to prevent decades-long misdiagnosis and morbidity. This abstract is funded by: None
Varma et al. (Fri,) studied this question.