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Post-Plombage Retained Foreign Object Resulting in Recurrent Infections
Post-Plombage Retained Foreign Object Resulting in Recurrent Infections Chinenye O. Iwuchukwu, MPH, MD, and Robert F. Dunton, MD Division of Cardiothoracic Surgery, SUNY Upstate University Medical Center, Syracuse, New York
Fig 1.
A
71-year-old man with a history of tuberculosis (Tb) as a teenager and an unknown pulmonary procedure was evaluated for a nonhealing wound in the left axilla and posterior back. Computed tomography of the thorax revealed an abnormality in the left thorax (Figs 1, 2). Granulomatous disease was diagnosed, and the patient was referred to the thoracic multidisciplinary clinic at our institution for further evaluation. Given the history of Tb and the pulmonary procedure, there was a high index of suspicion that the patient underwent a prior plombage procedure. A wound exploration was planned with intent for thoracotomy and possible lobectomy if indicated. We proceeded with an incision and dissection below the draining sinus tract, and we retrieved 296 cm of tubing (Fig 3). The patient underwent a pectoralis rotational flap for closure of the defect, and he has done well postoperatively. Post-plombage patients are evaluated decades after their original procedure with chronic pulmonary infections, nonhealing thoracic wounds, or sepsis. These patients undergo extensive diagnostic tests resulting in Address correspondence to Dr Dunton, Division of Cardiothoracic Surgery, SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210; email: [email protected].
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
Fig 2.
delay in diagnosis. In most cases, a retained foreign object is not usually a part of the diagnosis, and the disease process is believed to be indolent because of nonresponse to attempted medical or surgical treatments. Our patient was treated for recurrent pulmonary infections with debridement and prolonged antibiotics. This case is also interesting because the tubing simulated an appearance of lung disease, and a retained foreign object was never considered as part of the diagnosis.
Fig 3. Ann Thorac Surg 2016;102:e575 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2016.05.104
Fig 1.
A
71-year-old man with a history of tuberculosis (Tb) as a teenager and an unknown pulmonary procedure was evaluated for a nonhealing wound in the left axilla and posterior back. Computed tomography of the thorax revealed an abnormality in the left thorax (Figs 1, 2). Granulomatous disease was diagnosed, and the patient was referred to the thoracic multidisciplinary clinic at our institution for further evaluation. Given the history of Tb and the pulmonary procedure, there was a high index of suspicion that the patient underwent a prior plombage procedure. A wound exploration was planned with intent for thoracotomy and possible lobectomy if indicated. We proceeded with an incision and dissection below the draining sinus tract, and we retrieved 296 cm of tubing (Fig 3). The patient underwent a pectoralis rotational flap for closure of the defect, and he has done well postoperatively. Post-plombage patients are evaluated decades after their original procedure with chronic pulmonary infections, nonhealing thoracic wounds, or sepsis. These patients undergo extensive diagnostic tests resulting in Address correspondence to Dr Dunton, Division of Cardiothoracic Surgery, SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210; email: [email protected].
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
Fig 2.
delay in diagnosis. In most cases, a retained foreign object is not usually a part of the diagnosis, and the disease process is believed to be indolent because of nonresponse to attempted medical or surgical treatments. Our patient was treated for recurrent pulmonary infections with debridement and prolonged antibiotics. This case is also interesting because the tubing simulated an appearance of lung disease, and a retained foreign object was never considered as part of the diagnosis.
Fig 3. Ann Thorac Surg 2016;102:e575 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2016.05.104