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Description
A 40-year-old man with a history of childhood asthma and recurrent pneumonia was admitted to hospital with fever, shortness of breath and mild productive cough. A chest X-ray showed cavitating right middle lobe opacity (figure 1). Subsequent CT scan with three-dimensional reformats confirmed an irregular thick-walled air containing lesion in the right middle lobe in keeping with a pulmonary abscess. In addition, a high density foreign body that measured 2.6 cm in length was seen within the right middle lobe bronchus (figure 2). The proximal end of the linear foreign body was covered by irregular soft tissue densities (figure 3).
A rigid bronchoscopy was undertaken, which revealed a dress pin in the right middle bronchus. Polypoid appearing soft tissues were seen in the distal bronchus intermedius, covering the proximal end of the dressing pin and partially obstructing the right bronchus intermedius and right middle lobe bronchus. Partial occlusion of the airway caused a secondary bacterial pneumonia with cavitation. The pin was removed.
Follow-up flexible bronchoscopy 2 months later showed no progression of the polypoid soft tissue at the distal bronchus intermedius (figure 4). Endobronchial biopsy of this lesion revealed no acute inflammation, granulomatous formation or malignancy. This would be in keeping with fibrous tissue. Subsequent chest X-ray revealed complete resolution of lung abscess (figure 5). The patient was followed up in clinic over the next 12 months and appeared to make a full and uneventful recovery with no asthma symptoms.
Further clinical history revealed that the patient's mother was a dress maker. The patient and his family could not recall any foreign body inhalation. It is likely he inhaled the dress pin as a child, resulting in recurrent pneumonia and, eventually, pulmonary abscess formation due to the significant amount of fibrous tissue that had developed around it. Previous literature review reveals a syndrome known as Turban pin aspiration syndrome, but no relevant history reveals actual cases of it.1
Learning points
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Unsuspecting foreign body inhalation would need to be considered as a diagnostic possibility when there has been unexplained recurrent pneumonia.
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Fibrous tissues can develop around a chronically inhaled foreign body over time and cause obstruction to the bronchial lumen.
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CT-chest with three-dimensional reformat is a non-invasive imaging method that has potential for proper localisation of the foreign body in the airway.
Acknowledgments
The authors thank to Monash Lung & Sleep and Monash Radiology Department for their support.
Reference
Footnotes
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Contributors PML and AKMNU performed the bronchoscopy and were the corresponding physicians for the patient, and DM was the respiratory physician. KL was our senior radiologist and provided his valuable input from the radiological point of view.
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Competing interests None.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.