C44-07 Chronic Tracheobronchial Foreign Body Aspiration Presenting as Granulation Tissue and Hemoptysis in an Adult: A Case Report

Introduction Tracheobronchial foreign body aspiration is often an immediate life-threatening condition that requires prompt recognition and management. Chronic tracheobronchial foreign body aspiration (CTFBA), while uncommon, can result in chronic inflammation and formation of granulation tissue. Complications such as hemoptysis and airway compromise may serve as sentinel symptoms indicating underlying foreign body aspiration requiring immediate attention. Case Report A 75-year-old man with a history of chronic obstructive pulmonary disease and paroxysmal atrial fibrillation on apixaban presented with acute hemoptysis and progressive shortness of breath. Two days before presentation, he expectorated a tablespoonful of blood, which subsequently increased in volume and developed severe shortness of breath. Computed tomography of the chest demonstrated a large distal tracheal mass occluding 80-85% of the tracheal lumen, extending and completely occluding the left mainstem bronchus. Rigid bronchoscopy with tumor debulking was performed using multimodal techniques of cryoextraction, hot forceps, and argon plasma coagulation. After successful recanalization of the distal trachea, a circular, flat, plastic foreign body was also identified within the proximal left mainstem bronchus. This was removed using flexible forceps. Histopathology from the tracheal mass revealed necrotic and inflammatory debris, fibrin, and granulation tissue with the ulceration. No malignancy was found. The findings were consistent with benign granulomatous inflammation secondary to foreign-body aspiration. Postoperatively, the patient developed mild self-limiting hemoptysis and left lower-lobe obstructive pneumonia, which was treated with cefepime and vancomycin. Discussion CTFBA is a rare presentation in adults and can present with nonspecific symptoms. Maintaining a high index of suspicion of CTFBA with formation of granulation tissue even in the absence of a relevant recent history is an early priority during the initial differential diagnosis. In the present case, the abrupt onset of hemoptysis and worsening dyspnea without a plausible explanation broadened the possibilities of the underlying etiology, lowering clinical suspicion. Computed tomography was an invaluable tool in delineating the location, size, airway wall involvement, and presence of inflammation or obstruction. However, as illustrated in this case, bronchoscopy is the gold standard diagnostic and therapeutic modality. Careful preoperative planning and execution of foreign body extraction and mass debulking are essential, especially in the presence of extensive airway involvement. In the present case, the presentation of hemoptysis likely reflected the sequelae of ulceration or vascular erosion within longstanding granulation tissue. Even in the post-extraction period, bleeding can continue to recur, and other complications such as pneumonia should be anticipated and mandates vigilant postprocedural management. This abstract is funded by: None