ABSTRACT Forgotten childhood foreign body aspiration may present in adulthood as chronic bronchial obstruction, creating substantial diagnostic challenges. A 45‐year‐old man with a history of recurrent pneumonia in childhood had an abnormal chest shadow on routine examination without recollection of choking episodes. Chest computed tomography demonstrated complete obstruction of the right basal bronchus with atelectasis. Bronchoscopy revealed inflammatory changes and an occluded bronchus with viscous secretions. Differential diagnosis included pulmonary sequestration, bronchial atresia, and malignancy. Right middle and lower bilobectomy was performed because malignancy could not be excluded. Pathological examination unexpectedly identified a 12‐mm plastic air pistol pellet encapsulated by thick fibrous tissue, indicating retention exceeding 30 years. Foreign body aspiration should remain in the differential diagnosis of chronic bronchial obstruction even when patient history and all preoperative diagnostic modalities fail to suggest this aetiology, particularly in patients with childhood respiratory illness.
Takeyama et al. (Sun,) studied this question.