Eur J Cardiothorac Surg 2007;31:309-310. doi:10.1016/j.ejcts.2006.11.026
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Images in cardio-thoracic surgery |
Unusual retained foreign body in the lung: a tree branch
Flora H.F. Tsang,
Alan D.L. Sihoe*,
Lik-Cheung Cheng
Division of Cardiothoracic Surgery, Department of Surgery, The University of Hong Kong, Grantham Hospital, Hong Kong SAR, China
Received 19 September 2006;
received in revised form 19 September 2006;
accepted 7 November 2006.
* Corresponding author. Tel.: +86 852 2518 2111; fax: +86 852 2647 3512. (Email: adls1{at}lycos.com).
Key Words: Foreign body • Lung • Trauma • Penetrating chest injury
A 30-year-old woman presented with intermittent hemoptysis for 3 years. Fifteen years earlier, she suffered penetrating injury to the chest after falling onto a pile of broken twigs (Fig. 1A). Imaging revealed a cylindrical lesion in the right upper lobe lung (Fig. 1B and C). The lobe was resected and found to contain a tree branch (Fig. 2
).
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Fig. 1. (A) A right anterior chest wall scar indicated the site of the penetrating injury, which occurred 15 years ago in another country. She was not aware of any deeper visceral involvement from that accident. The patient claimed that wound debridement under local anesthesia was given at the time, but was unable to give any further details of the injury or the management received. (B) Chest roentgenogram showed right upper lobe lung consolidation with a peculiar cylindrical hypodense center. Fibre-optic bronchoscopy demonstrated only a small amount of purulent sputum arising from the right upper lobe anterior segmental bronchus. (C) Computed tomography of the chest revealed a 7 cm long hollow tubular structure inside the right upper lobe, with complex infective changes in the surrounding lung parenchyma.
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Fig. 2. (A) The resected right upper lobe of lung was cut open to reveal a fully recognizable broken tree branch inside a cavity, which was lined with a thick fibrous capsule and which contained purulent, foul-smelling fluid. Histological analysis confirmed bronchiectatic change in the lung surrounding the cavity. (B) The tree branch traversed through the lateral aspect of the right upper lobe, and impacted into the inside surface of the sixth rib posteriorly. En bloc resection of a short segment of the sixth rib was required. The patient made a good recovery and had no further cough or hemoptysis.
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