A chronic intra-parenchymal foreign body mimicking lung cancer in a healthy adult: a case report

Foreign body aspiration (FBA) is rare in healthy adults and often presents with non-specific respiratory symptoms, leading to diagnostic delays. Chronic FBA can mimic pulmonary malignancies, particularly in the absence of a witnessed aspiration event, making diagnosis challenging and highlighting the novelty of such presentations. A 57-year-old Lebanese woman presented with a persistent productive cough, new-onset hemoptysis, and chest pain. Imaging revealed a hyper-metabolic pulmonary lesion with a maximum standardized uptake value (SUV max) of 5.3, raising suspicion for malignancy. Bronchoscopy was inconclusive, and a CT-guided biopsy of the lesion yielded negative results. Due to the peripheral location of the lesion and ongoing diagnostic uncertainty, a surgical wedge resection was performed. Intraoperatively, a wooden toothpick was discovered embedded in the lung parenchyma, surrounded by chronic inflammatory changes. Histopathological examination confirmed the absence of malignancy. Chronic FBA should be considered in the differential diagnosis of pulmonary nodules, even in healthy adults without typical risk factors or a clear history of aspiration. This case highlights the potential for foreign bodies to mimic malignancy and underscores the role of surgical intervention in achieving definitive diagnosis and management.