Unmasking Hidden Etiologies: Bronchoscopic Surprises in Chronic Pulmonary Symptoms: A Case Series

Persistent respiratory symptoms that fail to respond to standard therapy warrant systematic reevaluation to exclude occult airway pathology.Misdiagnosis is common when clinical and radiological findings are nonspecific or initially reassuring.We present two cases that highlight the diagnostic value of repeat bronchoscopy in such scenarios.The first case describes a 65-year-old male with chronic cough and dyspnea treated as asthma, later found to have a retained endobronchial foreign body causing segmental collapse, successfully retrieved using a flexible bronchoscope with complete symptomatic resolution.The second case involves a 63-year-old smoker with nonresolving consolidation initially attributed to organizing pneumonia based on computed tomography (CT)-guided biopsy but ultimately diagnosed as small cell carcinoma following repeat bronchoscopy.These cases emphasize that single-time-point investigations may be insufficient, and persistent symptoms or radiological abnormalities mandate reconsideration of diagnosis.Early and repeat bronchoscopic evaluation plays a pivotal role in identifying hidden airway obstruction or malignancy, thereby preventing diagnostic delay and improving patient outcomes.