Tooth aspiration mimicking airway carcinoid: a case report of delayed foreign body diagnosis in the right lower lobe

Introduction Foreign body aspiration in adults is frequently underrecognized, particularly when the aspiration event is unwitnessed or symptoms are chronic and nonspecific. Delayed diagnosis may result in recurrent respiratory symptoms, post-obstructive infection, and granulation tissue formation that can mimic endobronchial malignancy. Case presentation We report the case of a 72-year-old man presenting with chronic cough and recurrent lower respiratory tract infections. Computed tomography demonstrated obstruction of the lateral basal segment of the right lower lobe with post-obstructive changes, while bronchoscopy revealed a vascularized polypoid lesion highly suspicious for an endobronchial carcinoid tumor. Bronchoscopic resection using a snare and cryoprobe exposed a calcified foreign body beneath extensive granulation tissue. The foreign body was ultimately extracted using a combination of forceps and retrieval basket and was identified as a human tooth. Histopathological examination demonstrated granulation tissue without evidence of malignancy. Retrospective history revealed that the patient had lost a tooth during a syncopal episode approximately three years earlier. Conclusion This case highlights the diagnostic challenges associated with chronic foreign body aspiration in adults and emphasizes the importance of maintaining a broad differential diagnosis when evaluating endobronchial lesions. Granulation tissue surrounding aspirated foreign bodies may closely resemble neoplastic airway obstruction both radiologically and bronchoscopically. Careful history-taking and flexible bronchoscopic management strategies are essential for accurate diagnosis and successful treatment.