B46-22 Case Report: When Upper-Lobe Endobronchial Lesion Masquerades as Neoplasm Secondary to Inhaled Organic Plant Material (Popcorn Kernel)

Abstract Introduction Endobronchial lesions are frequently observed in patients with persistent respiratory symptoms and are often associated with infectious or malignant conditions. Foreign body aspiration is still a crucial differential diagnosis, nevertheless, particularly in adults. This case describes an endobronchial lesion in the right upper lobe of the lung, identified as retained organic material (a popcorn kernel) in an uncommon location, highlighting the diagnostic challenges and therapeutic approach. Case Description A 69-year-old Caucasian male, with a 40-pack-year smoking history, presented with worsening shortness of breath and frequent coughing. His medical history included chronic obstructive pulmonary disease, chronic hypoxic respiratory failure and multiple pulmonary nodules. He denied any history of dysphagia or aspiration. A chest computed tomography (CT) scan revealed a 7x7mm non-obstructive, partially calcified lesion in the right superior lobar bronchus Figures 1-3. Fiberoptic bronchoscopy identified a yellowish, granulation tissue-covered lesion adhered to the bronchial wall Figures 4. Although suspected to be a foreign body, removal was unsuccessful. Biopsies and bronchoalveolar lavage ruled out malignancy and confirmed the presence of an organic (plant) material. Cultures for bacteria, fungi, and acid-fast bacilli were negative, and a PET scan was deemed unnecessary. The patient underwent interventional bronchoscopy and 1.7 mm cryoprobe was used to separate the organic foreign body from the surrounding airway as there appeared to be some granuloma formation - this was done with freeze-defreeze 3 second cycles using Co2 gas as cryogen. Once the foreign body appeared loose, Polygrab 2.0 retrieval basket was used to remove the foreign body Figure 5, revealing a popcorn kernel. The underlying airway mucosa appeared healthy Figure 6, and pathology was not required as the popcorn kernel was removed intact Figure 7. Conclusion Foreign body aspiration in adults is frequently underdiagnosed, particularly when symptoms are atypical and the location, such as the upper lobe of the lung, is unusual. Without a clear history of aspiration, recognition can be delayed. This case underscores the importance of maintaining a broad differential diagnosis for endobronchial lesions, including the consideration of foreign bodies, to prevent complications like persistent symptoms or secondary infections. When evaluating endobronchial lesions in adults, it is essential to consider malignancy, infection, and foreign bodies. CT imaging and bronchoscopy are critical tools for both diagnosis and treatment. Additionally, educating patients on the risks of aspiration and promoting safe eating practices are vital measures. This abstract is funded by: None