Value of multiplanar reconstruction in multi-slice computed tomography for the detection of foreign body in the pulmonary artery: a case report

Abstract

Multi-slice computed tomography (MSCT) is the primary method for the detection and visualization of foreign bodies in the pulmonary artery because it provides high sensitivity and accuracy. It is very difficult to diagnose a patient with a non-iatrogenic pulmonary artery foreign body who does not have a history of a penetrating trauma. This case report describes a 36-year-old male that presented with coughing and haemoptysis. Based on conventional coronal and cross-sectional CT, the foreign body was misdiagnosed as pulmonary tuberculosis and pulmonary artery thrombosis. During treatment of the bronchial artery embolization and anti-tuberculosis therapy, the patient continued to experience haemoptysis. After further analysis of the pulmonary artery CT angiography images and curved multiplane reconstruction, an approximately 6-cm long toothpick was identified in the pulmonary artery with an unclear entry route. After surgery to remove the toothpick, symptoms of coughing and haemoptysis were resolved. This current case demonstrated that multiplane reconstruction in MSCT can improve the detection and visualization of pulmonary artery foreign bodies, which can aid in the diagnosis of pulmonary artery diseases of unknown cause.

Keywords: Foreign body; computed tomography; multiplane reconstruction; pulmonary artery.

Figure 1.

Axial and coronal computed tomography images of a 36-year-old male who presented with coughing and haemoptysis showed that the focus was patchy, a local tree-in-bud sign was present (a, b, c, d) and the pulmonary artery had mural thrombus (e, f, g, h).

Figure 2.

Bronchial artery embolization in a 36-year-old male who presented with coughing and haemoptysis. The left bronchial artery was observed from the right wall of the thoracic aorta, exhibiting thickening and twisting. Within the upper lobe of the left lung, a large number of disorderly arranged clusters and reticular vessels were observed (a). Small areas of contrast medium overflow staining were seen in the parenchymal phase, along with the presence of a bronchial artery-pulmonary artery shunt (b). After embolization, the responsible blood vessel was occluded and the original contrast agent overflow staining disappeared (c, d).

Figure 3.

Computed tomography angiography images of a 36-year-old male who presented with coughing and haemoptysis. Persistent patchy lesion in the posterior segment of the left upper lobe apex (a, b). The lesion was located in the pulmonary artery at the proximal end, with surrounding thrombosis and surrounding inflammatory tissue wrapping at the distal end (c, d, e). Linear high-density lesion in the area of the pulmonary artery running along the posterior segment of the left upper lobe apex (f, g, h).

Figure 4.

Axial and coronal computed tomography images of a 36-year-old male who presented with coughing and haemoptysis showed a local cavity with a high-density shadow within the cavity (a, b). Curved multiplanar reformation reconstruction images showed a distinct linear high-density shadow running along the pulmonary artery branch and passing through the cavity (c, d).

Figure 5.

Intraoperative photography of a 36-year-old male who presented with coughing and haemoptysis. A complete toothpick approximately 6 cm in length (a) and a proximal massive thrombus (b) were discovered in the main pulmonary artery at the posterior segment of the left upper lung apex. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 6.

Postoperative follow-up computed tomography images of a 36-year-old male who presented with coughing and haemoptysis. The left pleural effusion has completely absorbed (a, b) and the left lower lobe of the lung was fully dilated (c, d).