C44-01 Suspected Endobronchial Tumor Revealed as Foreign Body Aspiration

Abstract Endobronchial lesions in smokers often suggest malignancy, but foreign bodies can closely mimic tumors on imaging and bronchoscopy, emphasizing careful evaluation to avoid misdiagnosis. A 58-year-old man with a 40-pack-year smoking history, chronic obstructive pulmonary disease with emphysema, and rheumatoid arthritis was referred after an abnormal low-dose CT chest obtained for lung cancer screening. Imaging showed a spiculated right upper lobe lesion (33 × 14 mm), an irregular left upper lobe nodule (18 × 15 mm), and nodular thickening of the proximal left mainstem bronchus (13 × 6 mm), all concerning for malignancy in the context of his smoking and family history of lung cancer. Spirometry demonstrated moderate airflow obstruction, consistent with his COPD. He reported chronic exertional dyspnea and intermittent cough with occasional sputum production but denied hemoptysis, fever, or weight loss.Flexible bronchoscopy under general anesthesia revealed a large white-brown object in the left mainstem bronchus, surrounded by multiple pink, bubble-like mucosal lesions resembling papillomatous squamous neoplasia. Initial bronchoscopic attempts with cryoprobe and forceps failed to extract the object, and it migrated proximally, causing near-complete airway obstruction. At this critical moment, the anesthesiology team removed the LMA, and under direct visualization with a McGrath video laryngoscope, CP forceps were advanced and successfully removed the foreign body, which was identified as a chicken bone fragment.The airway was then secured with an 8.5-mm endotracheal tube, and the mucosal lesions were treated with electrocautery snare and cryo-debridement until full recanalization was achieved. Endobronchial biopsies showed squamous metaplasia with hyperkeratosis but no dysplasia or carcinoma. Endobronchial ultrasound with mediastinal node sampling and cytology were negative for malignancy.This case highlights how adult foreign body aspiration can closely mimic endobronchial malignancy, even in high-risk smokers with concerning imaging and bronchoscopic findings. Granulation tissue encasing a foreign body may resemble squamous papillomatosis or carcinoma, making pathologic confirmation essential to avoid misdiagnosis.Foreign body aspiration in adults is uncommon and often presents with delayed, nonspecific symptoms. Because many patients do not recall an aspiration event, the resulting airway changes can be mistaken for infection or tumor. This reinforces the importance of considering foreign body aspiration in the differential diagnosis of suspicious endobronchial lesions.The case also underscores the need for procedural adaptability. Initial attempts at removal failed and airway compromise ensued, but the timely use of CP forceps under video laryngoscopic guidance allowed successful extraction. Multimodal therapy with electrocautery and cryo-debridement enabled full airway recanalization and safe tissue sampling. This abstract is funded by: none