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• W2272185416 abstract "Case ReportsHidden Foreign Body as a Cause of Recurrent Hemoptysis Jehoram Tei Anim and MB, ChB, FRCPath Tawfik Mohammed TamimiMB, ChB, PhD, FRCSI(Hon) Jehoram Tei Anim Address reprint requests and correspondence to Dr. Anim: College of Medicine (49), King Faisal University, P.O. Box 2114, Dammam 31451, Saudi Arabia. From the Department of Pathology and Surgery, King Fahd Hospital of the University, Al-Khobar Search for more papers by this author and Tawfik Mohammed Tamimi From the Department of Pathology and Surgery, King Fahd Hospital of the University, Al-Khobar Search for more papers by this author Published Online:1 Jan 1991https://doi.org/10.5144/0256-4947.1991.100SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionHemoptysis is a potentially serious condition that requires thorough investigation. The amount of bleeding is no index to the underlying pathology[1], and important causes include pulmonary tuberculosis, bronchiectasis, and chronic cardiorespiratory problems[2,3]. An inhaled foreign body as a cause of recurrent hemoptysis has received little attention in the English medical literature. Recently, Pattison et al[4] reported a case in a teenage girl. We present a case in a 67-year-old man and discuss aspects of management.CASE REPORTA 67-year-old farmer was seen because of recurrent hemoptysis of 8 months' duration, associated with chest pain and dyspnea of recent onset (5 days). He had no fever or night sweats. He was a heavy smoker and a diabetic, controlled on glyburide. He had coarse crepitations over the right lower zone, where chest x-ray study showed a consolidation that was confirmed by computed tomography (CT). Repeated cytological examination of sputum and bronchial lavage findings suggested an inflammatory process but were negative for malignant cells, except for some atypical cells that suggested malignancy. Fiberoptic bronchoscopy revealed a polypoid structure in the medial basal segment of the right lower lobe which was difficult to biopsy adequately. Multiple semiblind biopsy specimens showed chronic inflammatory changes. PPD test was positive but sputum examinations were negative for acid-fast bacilli.In view of the suspicion of malignancy because of cytological findings, a right lower lobectomy was performed. Dissection of the specimen revealed a foreign body with a leaf-like appearance embedded in a basal bronchus (Figure 1), with surrounding inflammation. Histopathological examination showed squamous metaplasia and dysplasia of the epithelium, with severe chronic inflammation and scarring in the surrounding lung tissue. The plant nature of the foreign body was confirmed by histological analysis and later identified as the skin of a pepper fruit by the Institute of Agriculture. The patient made an uneventful recovery and has had no further hemoptysis over 2 years of follow-up.Figure 1. Resected lung specimen with bronchus opened to show foreign body against white background.Download FigureDISCUSSIONForeign body inhalation is more common in children and may thus be suspected as a cause of hemoptysis in that age group. In adults, however, it is less common and easily ignored, once the acute manifestations have subsided. The resultant hemoptysis may thus suggest a more sinister condition, making thorough investigation mandatory. Johnston et al[1] have stressed the importance of bronchoscopy as part of the initial investigation in men over the age of 40 who present with hemoptysis, in view of the increased likelihood of carcinoma. Our patient fell into this category.The difficulty of obtaining an adequate biopsy from the mass, together with the suspicion of malignancy based on cytological evidence, made thoracotomy mandatory. Lobectomy was indicated by the localization of the consolidation to the right lower lobe. The presence of a foreign body accounts for the dysplasia which was thought to be malignancy because of some atypical cells seen on cytological examination. If a foreign body remains in place, this usually leads to recurrent infections, thus making antibiotic treatment alone inadequate. In our case, resection proved curative.The usefulness of CT and digital subtraction angiography in localizing a foreign body has been proposed[4], especially where a chest radiograph is normal and bronchoscopy findings unhelpful. Digital subtraction angiography could have aided in the detection of the foreign body in our patient, but even with this our management would have been the same for the reasons outlined. If the foreign body is free and can be removed, resection would be unnecessary. For this reason, preoperative localization and bronchoscopic removal of a bronchial foreign body should be attempted in all cases of recurrent hemoptysis due to foreign body.In the case reported by Pattison et al[4], the foreign body was shaped like wild barley. In long-standing cases, secondary changes may alter the foreign body so much that it is unidentifiable. Proliferation of connective tissue or epithelium around the foreign body may further increase the difficulty in identification. In our case, the foreign body was conclusively identified as the skin of the pepper fruit.ARTICLE REFERENCES:1. Johnston RN, Lockhart W, Ritchie RT, Smith DH. Haemoptysis . Br Med J. 1960; 1:592–5. Google Scholar2. Poole G, Stradling P. Routine radiography for haemoptysis . Br Med J. 1964; 1:341–2. Google Scholar3. Conlan AA. Massive hemoptysis—diagnostic and therapeutic implications . Surg Annu. 1985; 17:337–54. Google Scholar4. Pattison CW, Leaming AJ, Townsend ER. Hidden foreign body as a cause of recurrent hemoptysis in a teenage girl . Ann Thorac Surg. 1988; 45:330–1. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 11, Issue 1January 1991 Metrics History Accepted17 April 1990Published online1 January 1991 InformationCopyright © 1991, Annals of Saudi MedicinePDF download" @default.
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• W2272185416 title "Hidden Foreign Body as a Cause of Recurrent Hemoptysis" @default.
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