A chest radiograph was obtained and was clear. Although the patient had been previously diagnosed with chronic bronchitis and emphysema, she presented with an unusual worsening of her chronic respiratory symptoms over the previous six months, which was unexplained by clinical examination or chest film. The admitting diagnosis was straightforward asthma and chronic bronchitis exacerbation. Her mental status remained intact throughout the course of her hospitalization. Computed tomographic scan of the chest.
Arrows designate a soft tissue density in the right lower lobe bronchus, indicating a foreign body.
On removal of the plug, the patient's acute and subacute symptoms subsided immediately. Bronchoscopic examination reveals a mucoid impaction with surrounding erythema and edema. The histologic examination revealed strips of plant tissue with prominent thick cell walls that were admixed with bacterial colonies, inflammatory debris, mucin and respiratory epithelial cells. The diagnosis of foreign-body aspiration with secondary mucoid impaction in healthy adults is subtle. Here, despite the localized unilateral position of the impaction, no roentgenographic signs such as volume loss or opacities were evident, and the clinical findings were bilateral.