Pyopneumothorax associated with unsuspected endobronchial foreign body: a case report

Chronic foreign body aspiration may cause a variety of complications. Nonspecific clinical presentations and chest radiographic manifestations often result in misdiagnosis or delayed diagnosis. We report an unusual complication of chronic foreign body aspiration--pyopneumothorax--in a 52-year-old patient presenting with productive cough and intermittent fever for more than 3 months. Obstructive pneumonia was highly suspected from the computed tomographic scan of the chest. Flexible fiberoptic bronchoscopy demonstrated a fish bone in the bronchial tree. The bone was successfully removed by forceps. Thoracotomy was done later to ensue adequate drainage of the pyopneumothorax. We report this case for ongoing education to increase the index of suspicion.