ENDOBRONCHIAL FOREIGN BODY ASPIRATION MIMICKING AN ENDOBRONCHIAL TUMOR

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Aspiration of foreign body (FB) into the airways may have an indolent presentation in adults. Although majority FB aspiration cases can be diagnosed easily and accurately by radiography bronchoscopy, some patients are misdiagnosed as having endobronchial tumors. We describe interesting case bronchus intermedius that mimicked tumor. CASE PRESENTATION: A 61-year-old, male long-time heavy smoker with history excessive alcohol use stroke residual left-sided hemiparesis presented a 3-month worsening dry cough, hemoptysis dyspnea. Chest computed tomography revealed occlusion enhancing lesion highly suspicious for obstructing bronchial mass, along moderate pleural effusion enlarged subcarinal lymphadenopathy. Thoracentesis showed exudative fluid predominantly neutrophilic cells was negative malignancy on cytology twice. Flexible bronchoscopy firm, causing near total intermedius. Forceps biopsy ultrasound-guided transbronchial needle (EBUS-TBNA) lymph node no malignant cells. The patient then underwent flexible removal occluding using cryoablation. mass appeared to freely movable when cryoprobe attached it. basket used retrieve entire resected which aspirated pill surrounded granulation tissue gross examination. Histopathology specimen evidence but consistent aspiration. DISCUSSION: Symptoms adults absent often delayed, reports up 26 months. Dysphagia impaired cough reflex main mechanisms This likely our use. In such invisibility chest imaging due formation tissue, overlooked patient, this further cofounded presence mediastinal lymphadenopathy, were concerning post-obstructive pneumonia. Bronchoscopic cryotherapy, resulted correct diagnosis has been described benign lesions recanalization. CONCLUSIONS: highlights importance suspecting evaluating airway lesions. Choice noninvasive method, bronchoscopic removing lesion, preclude need thoracotomy. REFERENCE #1: 1- Alharthi BJ, et al. Occult lung mimicking bronchogenic carcinoma. BMJ Rep. 2014;2014:bcr2014207438. Published 2014 Dec 17. doi:10.1136/bcr-2014-207438 #2: 2- Hewlett JC, Foreign adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-3409. doi: 10.21037/jtd.2017.06.137. PMID: 29221325; PMCID: PMC5708401. #3: 3- Sehgal IS, Use large tracheobronchial during bronchoscopy. Lung India. 2016 Sep-Oct;33(5):543-5. 10.4103/0970-2113.188978. 27625452; PMC5006338. DISCLOSURES: No relevant relationships Omar Abdulfattah, source=Web Response Muath Alsharif, Traves Crabtree, disclosure file Keivan Shalileh