S4448 Missed Denture Impaction in the Upper Esophagus Presenting as Aspiration Pneumonia and Airway Obstruction: A Diagnostic and Therapeutic Challenge

Introduction: Esophageal foreign body impaction is common in the elderly and may be easily missed, especially when the object is radiolucent, such as a denture. Delayed diagnosis may lead to life-threatening complications, including airway compromise, aspiration pneumonia, and esophageal perforation. We present a challenging case of a missed denture impaction initially misdiagnosed as aspiration pneumonia, requiring urgent multidisciplinary intervention. Case Description/Methods: A 68-year-old man with advanced dementia and edentulism presented with a 5-day history of progressive dysphagia, hoarseness, cough, and shortness of breath. He had been treated empirically for aspiration pneumonia at an outside facility without improvement. On admission, he was afebrile but tachypneic, with oxygen saturation of 89% on room air. Auscultation revealed inspiratory stridor and decreased right lung breath sounds. Examination showed drooling, muffled voice, and pooling of secretions. Chest X-ray was inconclusive. A non-contrast computed tomography neck revealed a radiolucent structure in the upper esophagus at the C6–C7 level, with adjacent soft tissue swelling and mild tracheal compression. Otolaryngology was consulted due to suspected upper airway foreign body. Flexible laryngoscopy revealed posterior pharyngeal bulging. GI was urgently involved for esophageal endoscopy. Upper endoscopy under general anesthesia revealed a partial denture impacted transversely across the cervical esophagus, with its metal clasps embedded into the mucosa. The denture was partially obscured by granulation tissue and adherent food debris. Gentle disimpaction was performed using a rat-tooth forceps with an overtube for airway protection. Minor mucosal bleeding was controlled with topical epinephrine. Post-procedure, the patient had immediate resolution of stridor and was transitioned to broad-spectrum antibiotics. No perforation was noted. A repeat endoscopy at 10 days showed healing without stricture. He regained full oral intake and was discharged in stable condition. Discussion: Denture impaction can mimic pneumonia or laryngitis, particularly in non-verbal or cognitively impaired patients. Computed tomography and early endoscopy are key to diagnosis and management. Multidisciplinary care prevents serious complications. Conclusion: This case illustrates the diagnostic challenge posed by radiolucent denture impaction and emphasizes the importance of early imaging and airway-aware endoscopic retrieval in elderly patients with atypical upper aerodigestive symptoms.