Chili pepper aspiration in elderly patients: a case series highlighting diagnostic challenges and the role of cryoextraction.

Background: Foreign body aspiration is a recognized clinical emergency, but chili pepper fragment inhalation remains an under-recognized etiology, particularly in elderly populations. This study aims to clarify the clinical and radiological characteristics, diagnostic challenges, and bronchoscopic management of such cases. Methods: We report two cases of elderly patients with subacute respiratory symptoms initially indicative of obstructive pneumonia or neoplasia. Both underwent extensive evaluation, including serial computed tomography (CT) and bronchoscopy. Results: In both cases, high-resolution CT scans demonstrated hyperdense, V-shaped, or annular opacities within bronchial structures (best visualized with mediastinal window settings) that were suggestive of an inhaled foreign body. Prominent indirect indicators included localized bronchial wall thickening, luminal narrowing, and post-obstructive parenchymal changes. Flexible bronchoscopy identified chili pepper fragments obstructing the distal airways. Cryoextraction successfully removed specimens intact without fragmentation. Follow-up revealed residual bronchiectasis but significant symptomatic improvement. Conclusion: Chili pepper fragment inhalation may be considered in cases of unexplained pneumonia, particularly in elderly populations or those with dietary habits involving small, sharp food items. CT imaging of hyperdense, V-shaped, or annular opacities within bronchial structures might provide valuable diagnostic clues, though radiographic findings may be subtle and non-pathognomonic. Bronchoscopy remains a key diagnostic and therapeutic modality, with cryoextraction demonstrating efficacy for extraction. Increased clinical awareness and prompt intervention are essential to prevent complications.