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• W2895743462 abstract "SESSION TITLE: Procedures SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Foreign body aspiration (FBA) in adults is uncommon and can have a varied clinical presentation making diagnosis challenging1. Delay in diagnosis can lead to sequela of recurrent infection, bronchiectasis and empyema. There have been several case reports in the medical literature of FBA mimicking malignancy2. We report a case of FBA mimicking solitary respiratory papilloma. CASE PRESENTATION: A 51 year old man with a history of COPD and polysubstance abuse was transferred to our institution for further workup of a lung mass and pneumonia. A prior CT chest showed a mass-like consolidation in the right upper lobe (RUL) with surrounding areas of consolidation, there were also enlarged right hilar and mediastinal lymph nodes. He was started on broad spectrum antimicrobial coverage and cultures were obtained. Pulmonary was consulted and decided to proceed with EBUS and airway inspection. Upon inspection there was an endobronchial lesion obstructing the right upper lobe orifice, with significant amount of purulent material distal, and biopsies were obtained. Pathology of the endobronchial lesion was consistent with squamous papilloma, the fine needle aspirate from the lymph nodes showed no carcinoma. Thoracic Surgery was then consulted for surgical management of his endobronchial lesion. Prior to resection they requested a CT guided biopsy of the RUL mass. While awaiting pathology results the patient expectorated a foreign body which pathology felt was consistent with bone, mostly likely non-human in origin. Retrospective evaluation of his initial CT chest showed an oblong, radiopaque density in the RUL bronchus. The patient was treated with a prolonged course of antibiotic therapy and follow up imaging showed near resolution of right upper lobe changes. DISCUSSION: Solitary respiratory papillomas are a rare cause of endobronchial obstruction and can undergo malignant transformation3. Given the updated clinical history pathology felt this most likely was reactive changes from the FBA. We surmised that manipulation of the endobronchial lesion and increased airway clearance maneuvers in the hospital may have led him to cough up the foreign body. He could not recollect any aspiration event which is not uncommon in more chronic cases of foreign body aspiration1. CONCLUSIONS: High suspicion of FBA based upon the clinical scenario may help lead to earlier diagnosis and treatment. Our patient fortuitously coughed up his foreign body leading to resolution of his obstructive pneumonia. Reference #1: Lan, RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J. 1994;7:510–14. Reference #2: Afghani, R., et al. Neglected foreign body aspiration mimicking bronchogenic carcinoma. Asian Cardiovasc Thorac Ann. 2016 Jul;6:601-3. Reference #3: Tryfon, S., et al. Solitary papillomas of the lower airways. J Thorac Oncol. 2012 Apr;7(4):643-8 DISCLOSURES: No relevant relationships by Charles Bengtson, source=Web Response No relevant relationships by Lewis Satterwhite, source=Web Response" @default.
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• W2895743462 date "2018-10-01" @default.
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• W2895743462 title "NO BONES ABOUT IT: AN UNUSUAL CASE OF FOREIGN BODY ASPIRATION" @default.
• W2895743462 doi "https://doi.org/10.1016/j.chest.2018.08.795" @default.
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