Computed Tomography Features and Diagnostic Pitfalls of Bronchial Chili Pepper Aspiration: Distinctive Morphologies and the False-Negative Peel—A Radiologic–Endoscopic Report of Two Cases

Background: Tracheobronchial foreign body aspiration (FBA) is a recognized clinical emergency; however, aspiration of chili fragments represents an underdiagnosed subtype, particularly in older adults. This report aims to characterize the spectrum of computed tomography (CT) manifestations and diagnostic pitfalls associated with chili fragment aspiration. Case Presentation: We report two elderly patients who presented with subacute respiratory symptoms initially mimicking post-obstructive pneumonia or bronchogenic malignancy. Both underwent thin-slice thoracic CT and flexible bronchoscopy. Case 1: A 65-year-old female whose CT revealed a sharp, V-shaped hyperdense opacity with a mean attenuation value of +598 HU, within the right lower lobe bronchus associated with distal obstructive atelectasis. Flexible bronchoscopy confirmed and extracted a chili fragment. Case 2: A 63-year-old male demonstrated a well-circumscribed, punctate hyperattenuating focus (+173 HU) in the right lower lobe bronchus, corresponding to an aspirated chili seed. Notably, an accompanying chili peel was retrieved endoscopically but was not separately identifiable on retrospective CT review. Both patients achieved complete symptom resolution following endoscopic extraction. Conclusions: In cases of unexplained pneumonia, particularly in elderly individuals and those with relevant dietary habits, the possibility of chili fragment aspiration should be considered. CT imaging of hyperdense, V-shaped, or punctate opacities within the bronchial tree may provide valuable diagnostic clues. However, chili peels may not be identifiable on retrospective CT review. Radiologists should be aware that a negative chest CT does not exclude the presence of an organic foreign body. Maintaining clinical vigilance and integrating endoscopic evaluation are essential for accurate diagnosis and complete removal of the foreign body.