Case Report
A 41-year-old from rural part of the country presented to the emergency
department with severe
respiratory distress, fever, productive purulent sputum & left sided
chest pain. The patient gave
history of long-standing recurrent chest infections extensively treated
with antibiotics. A remote
history of chest trauma following a fall was obtained. No previous
X-rays were available for
comparison. At the time of admission her respiratory rate was 42 breaths
per minute, blood
pressure of 108/65 mm of Hg and a pulse rate of 128 beats per minute.
She was immediately
admitted in ICU and underwent intubation. Total count at the time of
presentation was 14,200
per cc which elevated to 27,100 per cc on 2nd day.
Streptococcus pyogenes was isolated from
sputum.
Chest X-ray showed volume loss & complete opacification of left lung
with interspersed cystic
areas indicating bronchiectasis with a dense obliquely oriented fibrotic
band in right lung upper
lobe, as evident on CT tomogram image (Figure 1).
High resolution computerized tomography (HRCT) of the chest revealed a
dense thick walled
tubular fluid filled structure traversing the carina extending to the
left main bronchus with
marked volume loss with multiple fluid filled cystic bronchiectasis
suggestive of superadded
infection (? abscess) (Figures 2A and 2B) A thick walled air-filled
fibrotic tract in right lung
upper lobe appearing contiguous with the foreign body and extending to
axillary soft
tissue (Figures 3A & 3B). 3-D images show the orientation of tubular
foreign body within the
chest (Figure 4). No pneumothorax was noted. Bronchoscopy was planned
but the patient
couldn’t tolerate the procedure.
Despite aggressive treatment her condition deteriorated quickly and she
developed acute renal
failure. Within 48 hours of presentation she succumbed to septic shock
and multiorgan
failure.