Late-diagnosed pea aspiration in an adult mimicking a mass-like right lower-lobe lesion and requiring basal segmentectomy: A case report.

Tracheobronchial foreign body aspiration (FBA) is potentially life-threatening. In adults, delayed diagnosis may occur because symptoms are nonspecific and organic foreign bodies can be radiolucent, leading to recurrent infection, granulation tissue, and surgical resection. A 46-year-old Arab man with hypertrophic cardiomyopathy and hypertension presented with fever, productive cough, and grade II dyspnea 15 months after accidental pea aspiration. Chest computed tomography (CT) demonstrated a focal basal right lower-lobe mass-like consolidation, corresponding to the surgically treated basal segments, without a definite radiopaque intraluminal foreign body. Flexible bronchoscopy achieved only partial removal, and histopathology confirmed plant material with nonspecific chronic inflammation. Despite conservative treatment, he deteriorated with foul-smelling purulent sputum and persistent inflammation. Because of failed conservative/endoscopic management, bronchial strictures, and vegetative inflammatory lesions, he underwent right lower-lobe basal segmentectomy via thoracotomy. Surgery revealed marked induration, consolidation, and a purulent collection. Final pathology showed chronic suppurative inflammation with lymphoid follicles and purulent material, plus a 1.3-cm sclerosing nodule with papillary formations; immunohistochemical evaluation was requested to further exclude an associated neoplastic process. At 2-week follow-up, he improved clinically, and chest radiography showed no residual or recurrent focal mass-like consolidation. Adult FBA may mimic malignancy or chronic infection. CT is essential for identifying secondary postobstructive changes, although the foreign body may not be directly visible. Delayed presentation increases the risk of granulation, infection, and failed bronchoscopic retrieval. Delayed organic FBA should be considered in persistent focal lower-lobe consolidation; early CT and bronchoscopy may prevent complications and surgery.