Thoracoscopic Removal of a Transvenously Penetrated Foreign Body into the Pulmonary Artery due to a Trauma—Report of a Case—

Abstract

We have thoracoscopically removed a foreign body, which might be a metal piece, stabbed his left forearm due to a trauma and transvenously penetrated into the periphery of the lung artery. The patient was a 30-year-old man. During his metal processing, part of the metal had broken and an about 5-mm sized piece stabbed his left forearm. X-ray film showed a foreign body in the deep of the forearm, and surgery to remove the foreign body was scheduled on the next day. X-ray film taken before surgery revealed no foreign body, but a chest X-ray film showed a small nodule of metal concentration in the right middle lung field, leading to a suspicion of an intrathoracic foreign body. A chest CT scan detected an about 5-mm sized foreign body at the periphery of the upper lobe of right lung (S3). We made a plan to remove it by partial lung resection. We considered that intraoperative palpation or exploration using translucent procedures was difficult, and performed peripheral marking with CT. Surgery was started with general anesthesia and in the left lateral position, and thoracoscopic partial lung resection was performed. After we confirmed that the X-ray filming of the surgical preparation actually contained the foreign body, we terminated surgery. The thoracic drain was removed on the postoperative day 2 and the patient was discharged home on the 4^th postoperative day. In order to remove a foreign body which is small and cannot be confirmed by visual recognition, peripheral marking with CT is useful.