Abstract Case Presentation A 72-year-old ex-smoker presented to the Respiratory clinic in December 2024 with a 3-month history of persistent cough, productive of green sputum and haemoptysis. He was referred when symptoms did not resolve after treatment with oral Amoxicillin. His background history included allergic rhinitis, asthma and polymyalgia rheumatic, as well as recent travel to the Amazon rainforest. A CT chest demonstrated a 24mm abnormal soft tissue lesion around the lingula bronchus, with necrotic appearances peripherally and cystic component laterally. There was almost complete collapse of the Left Upper Lobe (LUL). PET-CT revealed avid FDG uptake in the lingula bronchus and a separate cystic component peripherally (figures 1c and 1d). These were suspicious for malignancy or infection, with radiological staging of T2aN0/1M0 if malignant. A flexible bronchoscopy showed an endobronchial lesion distal to the lingula orifice. Biopsies demonstrated vegetable matter and chronic inflammation, without malignancy. Cultures of bronchial lavage grew Klebsiella Pneumoniae, therefore a 2-week course of oral Co-amoxiclav was commenced. Repeat CT showed worsening occlusion of distal LUL bronchus and total collapse of LUL. Therefore, Rigid Bronchoscopy (RB) was arranged to remove the foreign body (FB) (figure 1a) and repeat biopsy (figure 1b) for suspected malignancy given progression of disease seen on CT. Histopathology showed vegetable material, fibrosis and chronic inflammation, without evidence of malignancy. The patient’s symptoms improved which correlated with resolution on CT with LUL re-expansion. Follow-up bronchoscopy showed improved, but persistent granulation tissue, without evidence of malignancy or infection on lavage. Conclusion FB aspiration in adults is uncommon, and, if not immediately identified, it may present with nonspecific respiratory symptoms. Chronic retained material can cause infection, inflammation or airway obstruction, which can mimic endobronchial malignancy. This case presented a few diagnostic challenges. Initially there was a lack of a clear history of aspiration, although in retrospect the patient stated that he may have aspirated a FB whilst in the Amazon Rainforest. Secondly, the LUL bronchus is not a common location for retained FB, therefore, this atypical finding required further investigation. Lastly, the radiological findings, including PET avidity and progressive lobar collapse, mimicked that of enlarging endobronchial malignancy. This findings, taken together, raise the possibility of concurrent FB aspiration, infection and malignancy, all of which warranted further investigation. A multidisciplinary approach with rigid bronchoscopy were essential in establishing the correct diagnosis and successful management of this patient. This abstract is funded by: None
Power et al. (Fri,) studied this question.