Abstract
A 75-year-old man presented at our clinic because of a massive hemoptysis. He had been injured by fragments of a hand grenade 52 years earlier, some of which had followingly been removed from the soft tissie of his back. He had since been asymptomatic. A chest X-ray film disclosed a metallic foreign body in the right upper lung field. Bronchoscopy revealed a foreign body impacted at the orifice of the right B^2 bronchus. Digital subtraction angiography demonstrated a hyper-vascular right bronchial artery, with shunting between bronchial and pulmonary arteries. CT scan also revealed bronchiectatic changes distal to foreign body. We performed a right upper lobectomy. The postoperative course was uneventful. Bronchoscopic removal of foreign body is safe to do with low complication rates, and therefore accepted as the first choice. Surgical interventions are sometimes required, however, especially when the foreign body is located in such a position as is anatomically difficult to access bronchoscopically, or when massive hemorrhage is likely following removal of it. Long-standing intrabronchial foreign bodies, like the one shown above, may better by surgery because of the racemose bronchial arteries as well as the secondary bronchiectasis.
