An 85‐year‐old man with a history of type 2 diabetes, vascular disease and chronic kidney disease awoke with central sharp pleuritic pain radiating through to his back. He had been otherwise well leading up to this presentation. On examination, he had a temperature of 37.9°C, tachypnoea (respiratory rate, 25–30 breaths per minute), shallow breathing, and oxygen saturation of 88% on room air. Auscultation of his chest revealed vesicular breath sounds throughout both lung fields. Investigations showed a total white cell count of 16.6 × 109/L (reference interval, 4.0–11.0 × 109/L) and a C‐reactive protein level of 26 mg/L (reference interval, < 5mg/L). Chest x‐rays were unrevealing (Supporting Information). Differential diagnoses of pulmonary emboli, pulmonary sepsis and aortic dissection were considered. Computed tomography pulmonary angiography revealed a foreign body in the inferior portion of the right bronchus intermedius with the features of a pill (Box). On specific questioning, the patient reported having difficulties swallowing metformin the previous night, which was part of his therapeutic regimen for diabetes, although he did not report choking or coughing. Unfortunately, the patient suffered an unrelated fatal stroke before undergoing his planned bronchoscopy.
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