Scans and symptoms screamed cancer—but it was something much more bizarre
Key Takeaways
Vital Signs
Male
47 years old
Presents with year-long cough
Chest X-ray and CT administered
Large mass in right lung visualized
After so many years on the job, chances are you're rarely surprised anymore. If someone comes in with symptoms that look like lung cancer, it's typically lung cancer.
However, radiologist Justin Shafa, MD, shared what he considers the "case of the year" in a recent Instagram Reel, and it could turn everything you think you know totally upside down.
The Patient
A 47-year-old British man who smoked for 30 years presented with a year-long cough that wouldn’t quit. He initially presented to the ED 2 months earlier and was treated for pneumonia, but his symptoms had only worsened.
The Tests
Doctors initially did a chest X-ray. The results? His left lung base looked perfectly fine, but the right lung was a different story—showing consolidation, atelectasis, and a pleural effusion.
Next up was a chest CT that confirmed the concerning findings: a large mass-like consolidation in the right middle and lower lobes.
The next step: fluoroscopy. This was used to explore the airway and take a biopsy of the lung.
The Diagnosis
Dr. Shafa wondered: Is it chronic pneumonia? Some type of cancer? But what the fluoroscopy revealed was mind-blowing. It wasn’t anything close to a tumor.
Surgeons found a tiny traffic cone—like the one you’d find in a child's toy set—lodged in the patient's airway. He had swallowed it as a 7 year old—that's right, 40 years ago—and had promptly forgotten about it.
Now, it was causing chronic airway obstruction and mimicking a malignant mass on imaging.
Related: The strangest cases of patients whose dreams revealed shocking health revelationsThe Treatment
This remarkable case, published in the British Medical Journal in 2017, states that the traffic cone was removed successfully with flexible bronchoscopy. []
The Takeaway
This case underscores a vital clinical reminder: Even in smokers with classic “red flag” symptoms, not everything is cancer.
"This unusual case highlights the importance of clinical correlation and thorough investigation in diagnosing airway obstructions," Dr. Shafa wrote in his Instagram caption.
And yes, your pediatric airway foreign body knowledge may come back to haunt your adult practice.
Foreign body aspiration can remain silent for decades before causing chronic symptoms.
Imaging may not distinguish between a chronic inflammatory process and malignancy—biopsy remains crucial.
Never underestimate the power of a good clinical history (even if the patient doesn’t remember it).
