A Hard Lump to Chew: Delayed Diagnosis of Foreign Body Aspiration in an Elderly Man Leading to Severe Respiratory Failure

Foreign body aspiration (FBA) in adults is uncommon and often associated with risk factors such as advanced age and chronic alcohol abuse. It can constitute a serious emergency with acute symptoms secondary to airway obstruction, but there are cases in which it goes unnoticed, causing late complications with insidious symptoms and recurrent respiratory infections. We present the case of a 77-year-old male patient with a history of hypertension, type 2 diabetes mellitus, dyslipidemia, hyperuricemia, probable chronic obstructive pulmonary disease, chronic alcohol abuse, and gonarthrosis, who was admitted with acute respiratory failure. Initial diagnosis suggested hypertensive pulmonary edema; however, chest computed tomography revealed a foreign body in the right lower lobe bronchus. Flexible bronchoscopy confirmed the presence of the foreign body but failed to remove it. Subsequent rigid bronchoscopy successfully extracted an olive pit. The patient required mechanical ventilation and intensive care support but eventually recovered. This case underscores the importance of considering FBA in adults presenting with unexplained respiratory symptoms, especially those with predisposing factors.