case_images: PMC11288952_01
case_images: (A) Chest X-ray showing a consolidation in the right upper lobe indicating of pneumonia. (B-D) Computerized tomography (CT) in coronal and axial reconstruction demonstrated compression of the upper right bronchus and post-stenotic pneumonia of right upper lobe resembling lung cancer. (E-H) Computerized tomography in coronal and axial reconstruction 8 weeks post extraction of the cherry pit.
case_images: fmed-11-1404951-g001.jpg
case_images: PMC11288952_01_fmed-11-1404951-g001.jpg
case_images: fig1
case_images: The chest-X ray and a low dose CT scan demonstrated consolidation of the right upper lobe, with compression of the upper bronchus and poststenotic pneumonia and suspicious diagnosis of lung cancer (Figures 1A-D). Airways distal to obstruction were markedly bronchiectatic and altered (Figure 1).
case_images: (A,B) Flexible bronchoscopy revealing total obstruction of the right upper lobar bronchus by amorphous bronchial adenomatous hyperplasia, purulent secretion and abundant granulation tissue. (C) The right upper lobar bronchus after retrieval of the foreign body and adenomatous hyperplasia by flexible cryoprobe. (D) Macroscopic appearance of the aspirated material cherry pit with hyperplasia tissue and purulent secretions in a specimen container, after removal with cryoprobe. (E) Pathological examination of bronchial epithelial hyperplasia with reactively inflamed bronchial mucosa with chronic bronchitis with pseudopapillary epithelial hyperplasia (stars) and pronounced squamous epithelium metaplasia (arrow) (H&E, 20x). (F) Immunostaining of plant material (arrows) and secondary bacterial colonization by coccoid and filamentous bacteria (star) (H&E, 50x). (G,H) Immunostaining of detailed typical water-clear plant cells (G), polarized microscope image (H) with very characteristic birefringence as evidence of plant foreign material (H&E, 200x).
case_images: fmed-11-1404951-g002.jpg
case_images: PMC11288952_01_fmed-11-1404951-g002.jpg
case_images: fig2
case_images: Flexible bronchoscopy showed a complete occlusion of the right upper lobar bronchus by adenomatous hyperplasia tissue and purulent secretion resembling macroscopically a lung tumor (Figures 2A-D). The pathological examination of the tissue and foreign body revealed adenomatous hyperplasia and lympoplasmaceullar bronchitis with squamous epithelial metaplasia in the extracted tissue due to cherry pit aspiration, with no signs of dysplasia in the examined specimen (Figures 2E-H). The bronchial epithelial is reactively inflamed with chronic bronchitis and pseudopapillary epithelial hyperplasia and pronounced squamous epithelium metaplasia (Figure 2). The plant material (cherry pit) and secondary bacterial colonization by coccoid and filamentous bacteria could be well demonstrated (Figures 2A-H). Moreover, typical water-clear plant cells with very characteristic birefringence providing evidence of plant material, could be well observed with the use of polarized microscope (Figures 2G,H). Furthermore, in the final figure, the presence of a cherry pit foreign body within a specimen container, along with purulent secretions and bronchial hyperplasia tissue, was clearly visible (Figure 2D).
case_images: PMC11288952_02
case_images: (A,B) Computerized tomography (CT) in coronal and axial reconstruction demonstrated compression of the lower left bronchus, followed by mucus obstruction of the bronchi, and post-stenotic bronchiectatic actinomycosis. (C,D) Computerized tomography in coronal and axial reconstruction in follow up, months post extraction of the cherry pit, revealing complete resolution with remaining bronchiectasia distally. (E,F) flexible bronchoscopy of the left lower lobe at initial presentation revealed an actinomycosis in biopsy (E), and remaining obstruction in 2 years follow up, with the macroscopic appearance of the aspirated material, mimicking lung tumor (F).
case_images: fmed-11-1404951-g003.jpg
case_images: PMC11288952_02_fmed-11-1404951-g003.jpg
case_images: fig3
case_images: Chest radiograph revealed left lower zone consolidation with evidence of collapse (Figure 3A). Subsequent contrast enhanced computerized tomography (Figures 3A,B) demonstrated partial occlusion of left lower lobe with mucous secretion, bronchiectatic and altered, indicating for an actinomycosis infection. The mass was exerted with flexible cryoprobe (Figures 3E,F).