‘Missed’ inhaled foreign body in an adult

Abstract

fast bacilli or fungi, but showed light growth of Klebsiella and Proteus species. Transbronchial biopsies from the involved segment showed organizing pneumonia with no evidence of malignancy or granuloma. Following bronchoscopy the patient received 3 weeks of oral cefaclor without improvement. A repeat CT scan performed 12 months later suggested a progression of the lesion with new satellite nodules adjacent to the area of consolidation. The chronicity of the patient's symptoms, lack of response to antibiotics, failure to diagnose by bronchoscopy, and the suggestion of progression of CT scan prompted a diagnostic thoracotomy. At surgery the left lower lobe was noted to be adherent to the diaphragm. These adhesions were lysed and the lobe was mobilized revealing a dense consolidation with surrounding nodules and a foreign body which was protruding through the visceral pleura. The foreign body was extracted through the visceral pleura and identified as a leaf measuring 6 cm in length and rolled on its long axis (Plate 3). A segmental resection of the consolidated segment was performed. The surrounding lung showed organizing pneumonia with focal abcess formation, fibrosis, and calcification. Chronic inflammation was evident in the overlying pleura. The patient's postoperative course was uneventful and he was discharged without complications. Subsequent discussions with the patient led him to recall emerging from shrubbery with a choking sensation and cough after assault 2 1/2 years previously. He admitted to drinking alcohol prior to the incident. We suspect that aspiration of the leaf occurred at that time.