When Ingestion Is Actually Aspiration: Delayed Diagnosis of a Subglottic Foreign Body

Airway foreign body (AFB) is commonly encountered in young children but may present atypically in adolescents, contributing to a delayed diagnosis. We report a case of a previously healthy 14-year-old male who presented after choking on a plastic water bottle cap with persistent throat discomfort but no respiratory distress. Initial evaluation, including plain radiographs, esophagram, and computed tomography (CT) of the chest, was unrevealing, and the patient was discharged after tolerating oral intake. He returned two days later with persistent symptoms and new-onset hoarseness. Re-evaluation of CT imaging with dedicated review of airway structures revealed a radiolucent foreign body within the subglottic airway. The patient underwent successful removal via direct laryngoscopy without complications. We highlight key diagnostic challenges in AFB, particularly radiolucent objects and subacute presentations in older children. Negative initial imaging and absence of overt respiratory distress may provide false reassurance. A high index of suspicion, careful image review, and early airway-directed evaluation are essential to avoid delayed diagnosis and associated complications.