Wooden foreign body in the lung parenchyma.

Abstract

A 29-year-old pregnant woman came to the emergency department because of sudden shortness of breath. She had a history of intermittent respiratory tract infections that she attributed to smoking. A remote history of left chest trauma was obtained. The patient was unable to remember details of the incident but recalled that, while sledding supine on a piece of cardboard 1 2 years earlier, she had suddenly experienced severe chest discomfort. She was taken to a local hospital. A chest radiograph was obtained, and she was sent home to convalesce for 1 week. She was informed that she had residual “scarring” in the left lung. Physical examination at the current admission showed pronounced clubbing of the fingers and decreased breath sounds over the left hemithorax. A scar was noted at the inferior aspect of the left chest posteriorly, which the patient claimed was the result of the remote sledding accident. A chest radiograph showed a 50% hydropneumothorax. The chest radiographs made 12 years earlier were not available for comparison. The pneumothorax was treated by percutaneous aspiration. A follow-up chest radiograph showed complete resolution of the pneumothorax, a residual faint tubular density in the left upper lobe, mild volume loss of the left lung, and blunting of the left costophrenic angle (Figs. 1A and 1 B). During the ensuing months, the patient complained of intermittent cough with purulent sputum, hemoptysis, and left-sided chest discomfort. A CT scan of the chest obtained i 6 months after discharge from the hospital showed a cylindrical cavity in the left upper lobe containing a calcific density. This was interpreted as a calcified hematoma in a posttraumatic cyst (Fig. iC). The thickness of the wall of the cavity varied, up to 7 mm. Linear parenchymal densities surrounded the lesion, and localized bronchiectasis extended from the hilum. A transthoracic needle biopsy of the abnormality was performed. The lesion was described as “rock hard,” and the aspirate was “scanty”; Gram stain and cultures were negative. Because the patient had no clinical improvement after a long-term course of antibiotics, an inferior lingular segmentectomy and wedge excision of the anterior segment of the left lower lobe were performed. The excision specimen contained a wedge-shaped piece of wood 8 x 1 .6 x 1 cm (Fig. 2), which was enveloped in granulation tissue with fibrosis. Immediately adjacent to this in the lung was localized postobstructive bronchiectasis and organizing obstructive pneumonia.