A Recalcitrant Foreign Body

189 A54-year-old-woman with well-controlled mild intermittent asthma presented with a persistent cough productive of purulent sputum. She had no symptoms of dysphagia or gastroesophageal reflux disease. She had a remote 5-pack-year smoking history and previously lived in Lake of the Woods, Ontario, where her and her husband owned and operated a tree planting company for many years. There were no risk factors for tuberculosis nor travel out of country. Computed tomography of the chest (Figure 1A) revealed an obstructing calcified lesion within the anterior segment of the right upper lobe and calcified lymphadenopathy present in the right paratracheal region. Additional calcified granulomas were noted within the right middle and lower lobes. Flexible bronchoscopy confirmed the presence of an obstructing lesion within the anterior segment of the right upper lobe (Figure 1B). Attempts were made to extract the lesion via flexible bronchoscopy, but because these were unsuccessful, a rigid bronchoscopy was performed to remove the lesion (Figure 1C). Pathological examination was consistent with a broncholith, hypothesized to be related to blastomycosis infection given her occupation and residence in an endemic area, although cultures and fungal serology were negative.