[Staple line presenting as a suspicious pulmonary nodule]

Area of Science:

• Thoracic Surgery
• Diagnostic Imaging
• Pulmonology

Background:

• Recurrent primary spontaneous pneumothorax can necessitate surgical intervention, including thoracotomy and pleurectomy.
• Post-surgical changes can sometimes manifest as pulmonary nodules on imaging studies.
• Positron emission tomography (PET) scans are utilized to assess the metabolic activity of pulmonary lesions.

Observation:

• A 47-year-old female presented with a hypermetabolic right apical pulmonary nodule on PET scan.
• The patient had a history of right axillary thoracotomy with apical blebectomy and pleurectomy 18 years prior for pneumothorax.
• Percutaneous transthoracic needle biopsy of the nodule was unsuccessful.

Findings:

• Surgical exploration revealed the pulmonary nodule was composed of reinforcement material from a previous surgical staple line.
• The lesion was not a neoplastic or infectious process but a consequence of prior surgical repair.
• This represents a rare presentation of a post-surgical foreign body mimicking a pulmonary nodule.

Implications:

• Clinicians should consider prior surgical history, particularly the location of staple lines, when evaluating new pulmonary nodules.
• Awareness of this rare complication can prevent unnecessary invasive diagnostic procedures and associated risks.
• Careful review of surgical records and imaging correlation is crucial in diagnosing atypical pulmonary findings.