Clinical History
A 57-year-old male presented with a 3-week history of cough and pleuritic left-sided chest pain. Chest x-ray showed left upper lobe collapse with a large left-sided pleural effusion. Pleurodesis aspirated frank pus from the pleural cavity. Despite pleural drainage and antibiotic treatment, he later died.

Pathology
This specimen shows the lower trachea and main bronchi, which have been cut open, and the left upper lobe has been sliced to display the cut surface. At the origin of the left upper lobe bronchus, there is an impacted foreign body: an inhaled rabbit vertebra. As a result of the obstruction, the upper lobe has collapsed, pneumonia has developed, and the pleural surface is covered by fibrinous exudate. This represents an inhaled foreign body with associated collapse and pneumonic consolidation of the left upper lobe and empyema.

Further Information
Foreign body aspiration (FBA) occurs when a foreign body is inhaled into the airway causing partial or complete obstruction. This can be potentially fatal. It is more common in children than adults and is a leading cause of accidental death worldwide, especially in those under 1 year old and patients over 75 years. Risk factors for FBA in adults include decreased level of consciousness, drug or alcohol intoxication, or anesthesia. In the elderly, additional risk factors include medication use impairing cough and swallowing, stroke-related dysphagia, and degenerative neurologic diseases such as Alzheimer’s or Parkinson’s disease. Commonly aspirated foreign bodies in adults include inorganic items like nails, pins, and dental debris, and organic materials such as bones, improperly chewed meat, and watermelon seeds. Symptoms vary depending on the degree of airway obstruction. Larger obstructions may present as choking or sudden asphyxia, while smaller foreign bodies may cause more insidious symptoms such as cough, dyspnea, fevers, chest pain, and hemoptysis. Airway collapse distal to the foreign body leads to infection. Treatment involves retrieval of the foreign body with bronchoscopy or emergency tracheostomy.