Delayed Intrathoracic Textile Foreign Body Following Penetrating Shrapnel Injury Presenting with Expectoration of...

Retained intrathoracic and tracheobronchial foreign bodies are uncommon but important causes of chronic respiratory symptoms. Diagnosis may be delayed because presentations are nonspecific and retained textile material is often radiolucent. Such material can lead to chronic infection, pleural adhesions, and progressive lung destruction.

A 31-year-old Syrian male military serviceman and active smoker (20 pack-years) presented with a long-standing intermittent cough that had worsened over one week and become productive of white sputum. He also reported a single episode of expectorating suspected textile material, along with fatigue, weakness, and night sweats, but no fever, dyspnea, hemoptysis, or chest pain. Years earlier, he had sustained a penetrating shrapnel injury complicated by pneumothorax and later purulent pleural effusion requiring tube thoracostomy. On admission, examination suggested right basal involvement; laboratory studies were unremarkable, and tuberculosis testing was negative. Chest CT showed a heterogeneous right-sided lesion with right middle-lobe atelectatic change and tree-in-bud opacities, suggesting chronic inflammatory or infectious disease. Bronchoscopy revealed friable, bleeding mucosa and distortion at the right middle-lobe bronchial orifice.

Due to persistent symptoms and chronic localized abnormalities, right thoracotomy was performed. Dense pleural adhesions were found, and an intrathoracic textile foreign body was removed, most likely implanted during the prior traumatic injury. The right middle lobe was extensively destroyed with purulent change, requiring right middle lobectomy. Histopathology showed fibrosis, architectural destruction, fibroblastic foci, honeycomb change, and chronic inflammation consistent with a UIP pattern; adhesion fragments showed acute-on-chronic foreign body-associated inflammation.

Radiolucent textile foreign bodies may remain undetected for years after penetrating thoracic trauma and later present with chronic respiratory symptoms and localized destructive infection. Once irreversible damage is established, thoracotomy with foreign body removal and lobectomy may be necessary.