Accidental chest penetration of glass foreign bodies in a 53 year old lady-The challenges with video assisted thoracoscopic extraction

Abstract

Introduction: In rare cases, a foreign body may penetrate the thoracic cavity without the person's awareness. I report a case of the traumatic intrathoracic foreign body of glass implants that the patient did not have awareness about.

Presentation of case: The 53-year-old woman was unsteady on her foot and leaned against the sliding door of the glass in a washroom. She fell unto a crashing glass panel sustained chest injury, and then she noticed bleeding from the left chest. Dyspnea and chest pain were emergent gradually. Chest Computed Tomography (CT) showed two foreign bodies which she did not complain of in a left pleural cavity. We performed an emergency video-assisted thoracic surgery by the diagnosis of traumatic hemopneumothorax and the foreign bodies. We could remove two glass pieces.

Discussion: I found 15 cases of intrathoracic foreign body without the patient's awareness in a Japanese medical central magazine for the years 1993-2015. In some cases identifying a glass piece on perioperative X-rays may be difficult. Thus, all means for determining the accurate number of glass pieces and their approximate positions should be used, including multi-slice CT. I realize that a preoperative strategy is also important.

Conclusion: The patients who injured the chest with the glass without awareness of the implant of the foreign body, we take an intrathoracic foreign body by the penetration of the glass piece into consideration, need the search by the imaging. The extraction of the glass foreign bodies by VATS is very useful.

Keywords: Chest trauma; Hemopneumothorax; Intrapulmonary foreign body; Penetrating trauma; Video-assisted thoracic surgery.

Fig. 1

Chest radiograph, anteroposterior view, show two foreign bodies (arrows) in the left lower lobe [left]. CT scan clearly demonstrates the presence of two glass pieces in the left lower lobe (white arrow) and pleural effusion (black arrow) [right].

Fig. 2

Thoracoscopic photograph shows a foreign body (arrow) which was grasped by forceps before removal [left]. Photograph shows foreign bodies after removal. The long glass piece was removed from the intrathoracic space at first (long arrow), the short glass piece was removed from the right lung parenchyma through hardship last (short arrow) [right].