Foreign bodies in pleura and chest wall

In contrast to other locations, foreign bodies in pleura and chest wall have been rarely reported and there is no consensus with regard to treatment.

Between 1971 and 2001, 22 patients with foreign bodies in pleura or chest wall were admitted to our department. Their charts were reviewed for preoperative diagnosis, history, kind and location of the foreign bodies, length of retention, management of patients, and complications.

Three etiologic groups were identified: iatrogenic (11 patients), traumatic-intentional (10), and accidental (1). Foreign bodies were extracted in 21 patients: at thoracotomy in 6, direct pleuroscopy in 6, video-thoracoscopy in 4, and simple incision in 5. One foreign body was left behind because of objection of parents. There were no complications and no deaths. Follow-up lasted from one year to 7 years in 15 patients (68.2%). Seven patients did not show for follow-up.

Foreign bodies should be removed from pleura and chest wall, when possible. Small, blunt, peripherally located foreign bodies may be left behind if difficulties at extraction are anticipated. Thoracotomy may be needed for treatment of associated injuries, and for removal of materials used in plombage, because of adhesions. In others the use of videothoracoscopy is preferable. Physicians performing diagnostic and therapeutic procedures in anatomic proximity of pleura should exert utmost care to avoid iatrogenic introduction of a foreign body.