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.