Correct!
1. Aspirated foreign body
Given the rapid onset of symptoms and pulmonary parenchymal abnormalities in the lung parenchyma subtended by the affected airways, the complete absence of any lesion in the affected airways one year previously, and the hyperattenuating, faceted morphology of the two, distinct, endobronchial foci, aspirated foreign bodies are most likely. The involvement of the right bronchial system is also consistent with this impression. The hyperattenuating nature of the endobronchial foci raises the possibility of calcium, which can be seen with carcinoid and mucoepidermoid tumors, both of which are found in endobronchial locations, but there are causes of hyperattenuation at CT that can occur outside the context of a calcifying neoplasm. For example, non-neoplastic causes of calcification (such as infections and dystrophic calcification), metallic substances (such as iron), and plastic may all show hyperattenuation at CT imaging. The complete lack of any observable abnormality in the airways one year earlier is a strong argument against airway neoplasia as the cause of the findings in this patient.
Further clinical course: The patient underwent fiberoptic bronchoscopy which showed two endobronchial foci in the right mainstem bronchus and bronchus intermedius, consistent with foreign bodies. The lesions were extracted and found to represent two separate calcium and magnesium tablets. The airway adjacent to the foreign bodies was abraded, erythematous, and edematous, but no fixed obstruction was present).
Diagnosis: Aspirated endobronchial calcium and magnesium tablets.
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