Correct!
1. Aspirated foreign body causing post-obstructive bronchiectasis
Carcinoid tumor is a leading consideration for an endobronchial neoplasm that may result in post-obstructive phenomena, including bronchiectasis. Carcinoid tumors may also undergo calcification, and therefore may appear hyperattenuating at CT. Similarly, minor salivary gland neoplasms, including adenoid cystic carcinoma and mucoepidermoid carcinoma, may present as endobronchial lesions at CT scanning and may also cause post-obstructive changes. Furthermore, mucoepidermoid carcinomas have been shown to calcify, and therefore could manifest as a hyperattenuating endobronchial lesions at CT. Broncholithiasis from previous Mycobacterium tuberculosis infection could also present as a focal, hyperattenuating endobronchial lesion at CT causing post-obstructive bronchiectasis. However, both endobronchial neoplasia and broncholithiasis are unlikely in this patient because the lesion resected at surgery is clearly has regular, squared edges, consistent with an aspirated foreign body rather than either a neoplasm or a broncholith. Plastic bronchitis is a rare process characterized by rubber-like, obstructive, fibrinous, tracheobronchial casts that has been reported most commonly in pediatric patients with surgically repaired cyanotic congenital heart disease, particularly following a Fontan procedure, but also in patients with cystic fibrosis, asthma, pulmonary infections, and sickle cell disease with acute chest syndrome. This process has most often been described as multifocal in distribution and occasionally associated with extensive lung infiltration and even respiratory failure, and is typically neither focal nor hyperattenuating, and not associated with post-obstructive bronchiectasis.
Dissection of the surgical specimen revealed a foreign body (Figure 6).
Figure 6. The resection specimen was dissected and an endobronchial lesion was removed (A). The lesion was identified as a cap to a tube of superglue (B- Elmer’s Superglue).
The patient recovered uneventfully following surgery. He and his mother were then questioned regarding the etiology of the aspirated foreign body. The mother recalled at that when the patient was very young, approximately 5 years old, he had been playing with a cap to a superglue tube, but that this cap was subsequently “lost.” At this time the patient developed a cough that persisted for several months, which was attributed to a transient childhood illness, and subsequently resolved. The patient had been largely asymptomatic since that time, and it is likely that he presented now with a minor respiratory illness (recall the patchy areas of ground-glass opacity in the left lung at CT) which brought the aspirated foreign body to attention.
Diagnosis: Aspirated foreign body right lower lobe (glue cap), occurring in childhood, resulting in post-obstructive bronchiectasis
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