Incidental Right Hilar Metallic Density After Implantable Cardioverter Defibrillator Placement in a Tracheostomized Woman: Suspected Airway Foreign Body With Concurrent Pleural Effusion

Adult tracheobronchial foreign bodies are uncommon and can be subtle on radiographs, particularly in device-rich environments. An 80-year-old woman with severe heart failure underwent elective implantable cardioverter defibrillator (ICD) placement and had a linear right hilar radiopaque density and right basilar atelectasis/pleural effusion on postoperative portable chest radiography. She was stable on a tracheostomy collar without respiratory distress. Given the appearance and history of home tracheostomy care, a tracheostomy cleaning brush was suspected. Flexible bronchoscopy via the tracheostomy confirmed and retrieved a cleaning brush from the right bronchus intermedius; purulent secretions were irrigated, and there were no complications. The patient remained hemodynamically stable post-procedure. This case illustrates the value of correlating imaging with clinical stability yet proceeding to definitive airway evaluation when suspicion persists, and it highlights tracheostomy-care equipment as a potential source of iatrogenic foreign bodies in adults.