Intrathoracic gallstones: a case report and literature review

Abstract

Background: Laparoscopic cholecystectomy is one of the most commonly performed procedures in general surgery. There have been very few reported thoracic complications from this surgical procedure.

Methods: We report the case of a patient who underwent a laparoscopic cholecystectomy with gallstone spillage 34 months before presenting to the thoracic surgery service. The patient first complained of streaks of hemoptysis at 6 months from the time of the original procedure. A lower lobe infiltrate was noted and treated successfully with oral antibiotics. Over the next 2 years, the patient's symptoms waxed and waned.

Results: Due to the chronic infiltrate in his lung, a thoracotomy was performed that revealed erosion of the stone through the right diaphragm with formation of a lung abscess.

Conclusion: A high index of suspicion for a gallstone-related problem should be entertained by the practitioner when presented with a patient who has a right lung infiltrate and a history of open or laparoscopic cholecystectomy.

Figure 1.

Computed tomography of the chest shows eccentric calcification of a soft tissue mass in the lower lobe of the right lung.

Figure 2.

Transection of the gross lung specimen shows a gallstone encapsulated by surrounding fibrous reactive tissue.