An 80-year-old Japanese man was referred to our hospital with symptom of 7-month history of cough and pneumonia. He visited another hospital once due to persistent cough and was treated with antibiotics at that time. However, his symptom of cough was not improved. Therefore, he hesitated to visit a hospital because he had no symptoms except for persistent cough after then. Since he suddenly had neck pain for few weeks before, chest radiograph was taken. His chest radiograph showed a slight increase in opacity in the right lower lung (Figure 1A and 1B). His medical history was myocardial infarction at the age of 68 and percutaneous coronary intervention with stenting was placed. He had no remarkable family history. On admission, his vital signs were as follows: temperature, 35.9 °C; blood pressure, 126/64 mmHg; heart rate, 70 beats/min; oxygen saturation, 97 % (room air). His laboratory data were as follows: white blood cell count, 8590 /μL (neutrophil, 70.5 %); red blood cell count, 455 ×104 /μL; hemoglobin, 14.1 g/dL; platelet, 18.4 /μL. Liver and renal function was almost within normal range as follows: asparate aminotransferase (AST), 18 U/L; alanine transaminase (ALT), 13 U/L; alkaline phosphatase (ALP) 219 U/L; γ-glutamyl transpeptidase (γ-GTP), 13 U/L; lactate dehydrogenase (LDH), 176 U/L; creatinine (CRE), 1.12 mg/dL; blood urea nitrogen (BUN), 20 mg/dL. Lung-associated data and tumor markers were as follows: cytokeratin 19 fragment (CYFRA), 1.7 ng/mL; pro-gastrin-releasing peptide (ProGRP), 49.9 pg/mL; QuantiFERON, negative; mycobacterium avium complex antibody, negative; carcinoembryonic antigen (CEA), 2.0 ng/mL; carbohydrate antigen 19-9 (CA19-9), 17.7 U/mL; prostate specific antigen (PSA), 1.401 ng/mL. As shown in Figure 1C-1F, chest computed tomography (CT) revealed obstructive pneumonia in the right lower lung and a bronchial foreign body.
The patient clearly remembered that aspiration was performed approximately 11 months before, because he was choked on eating yellowtail fish. Therefore, we considered that his intrabronchial calcified structure on chest CT could be a fish bone. We performed bronchoscopy and detected a fish bone as an intrabronchial foreign body in the right lower lung and finally removed it from the bronchi (Figure 2A-2C).