Abstract Introduction Foreign body aspiration is common in children but often overlooked in adults at times, remaining undetected for years. Chronic airway obstruction and inflammation can mimic asthma, bronchitis, or bronchiectasis, while overlapping radiologic findings can delay diagnosis. This case highlights the diagnostic complexity and clinical importance of considering a retained airway foreign body in adults presenting with recurrent right middle lobe pathology and chronic cough. Case Description A 69-year-old non-smoking man with allergic rhinitis and hyperlipidemia was referred for evaluation of chronic cough and persistent right middle lobe (RML) consolidation on CT.1 His cough, productive of clear sputum, persisted for years despite empiric treatment for postnasal drip and infection. Serial CT scans from 2018-2023 demonstrated progressive RML bronchiectasis, with latter scans consistent with curvilinear opacity and endobronchial opacification, refractory to multiple courses of antibiotics and intravenous steroids. Pulmonary function testing and methacholine challenge were normal, and a modified barium swallow revealed only mild laryngeal penetration without aspiration.Given persistent focal disease, diagnostic bronchoscopy was performed, revealing a degenerated vegetable foreign body obstructing the RML bronchus. Cytology and cultures from bronchoalveolar lavage were negative for malignancy and infection.Following foreign body removal, the patient’s cough and sputum production markedly improved with near-complete resolution of cough and sputum production. Repeat CT demonstrated radiologic resolution of RML consolidation. He remained asymptomatic at follow-up while maintained on cetirizine and intranasal fluticasone. Discussion This case reveals an occult foreign body aspiration presenting as chronic right middle lobe bronchiectasis in an adult without aspiration history. It emphasizes that persistent, localized disease unresponsive to therapy mandates bronchoscopy to exclude endobronchial obstruction. The striking symptomatic and radiologic reversal post-removal underscores the potential reversibility of structural lung damage when the underlying cause is addressed. This case highlights bronchoscopy’s indispensable role in identifying hidden, treatable etiologies of chronic pulmonary disease. Importance This case highlights the critical need to consider occult foreign body aspiration in adults with chronic, localized bronchiectasis or non-resolving pneumonia. It emphasizes that persistent focal abnormalities despite optimal therapy warrant bronchoscopy to exclude an obstructive etiology. Recognition of this entity is vital, as timely intervention can be both diagnostic and curative, reversing years of symptoms and preventing progressive lung damage. Such vigilance can transform chronic, misattributed disease into a treatable condition with lasting recovery. This abstract is funded by: None
Saeed et al. (Fri,) studied this question.