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A6735 - Late Presentation of Retained Intrathoracic Foreign Body
Author Block: P. Kaur1, G. Elshimy2, B. Singh3; 1INTERNAL MEDICINE, New York Medical College at St Joseph Regional Medical Center, Paterson, NJ, United States, 2INTERNAL MEDICINE, New York Medical College at St.Joseph Regional Medical Center, Paterson, NJ, United States, 3Internal Medicine, New York College of Medicine at Saint Joseph Regional Medical Center, Paterson, NJ, United States.
Introduction: In the great majority of cases of long-standing intrathoracic foreign bodies, patients are asymptomatic. Rarely, transthoracic foreign bodies cause problems when left lodged in the pulmonary parenchyma. Early removal is required only in cases of pneumonia, lung abscess, empyema or proximity to a major organ . When left in place, bullets or other foreign bodies become surrounded over time by fibrous tissue and do no harm . Only few cases in literature reported symptoms that occur decades after the injury. Case report: We report a case of 37 years old Hispanic female with past medical history of Hypertension who presented to the emergency department with hemoptysis 10 years after having a bullet injury to her chest when she was on her home roof in Dominican Republic. Patient remained asymptomatic for 10 years and no intervention was done at the time of the incident. However, she started having recurrent small amount of hemoptysis along with retrosternal non-radiating chest pain and exertional shortness of breath for the past year. The only abnormal physical findings were the old healed scar at left 2nd intercostal space in midclavicular line and minimal rhonchi in left upper and lower lung fields on auscultation. Laboratory testing was normal including platelet count, coagulation test, kidney functions, urine studies and sputum smears for malignancy and infection. The chest x ray showed bullet fragment in left upper lung field and Computerized Tomography Angiography of the chest showed bullet fragment with surrounding infiltration in left upper lobe, peri-hilar ground-glass infiltrates secondary to pulmonary hemorrhage. Patient was hospitalized and bronchoscopy was done that showed bloody secretions in the apical segment of LUL which was successfully suctioned without an obvious source of bleed. Thoracic surgery was consulted but the plan was made to manage conservatively. Patient was discharged and was followed up afterwards for 1 year. No more episodes of hemoptysis were documented. Conclusion: Complications caused by foreign bodies retained in the lungs may arise many years after the initial injury. Among the symptoms and signs, hemoptysis is the most common. Our patient has the symptoms 10 years after the initial bullet injury. The management depends upon clinical scenario, if the patient has persistent chest wall pain or persistent purulent expectoration or hemoptysis, foreign body should be removed otherwise with minor and self-resolving episodes, conservative management is the treatment of choice.