Progressive cavitating lung disease due to apparent trans-diaphragmatic migration of obstetric tubing

Paul King, Peter Cole, Michael Farmer

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A 20 year old female Ethiopian refugee presented with a 6 month history of left shoulder tip pain and cough. A pre immigration chest X-ray demonstrated an infiltrate and pleural changes at the left lung base. No active tuberculous infection was detected on initial screening overseas. CT thorax performed in Australia revealed additional changes of cavitation and consolidation of the left upper lobe (LUL). Bronchoscopy and CT guided biopsy of the LUL were non diagnostic. Given a high clinical suspicion of tuberculosis, empiric quadruple anti- tuberculous chemotherapy was instituted. As a consequence of ongoing symptoms and progressive unusual cavitation within the LUL she proceeded to thoracotomy. A 20cm stiff plastic tube was found to perforate the left hemi-diaphragm and to extend into the apex of the LUL. A LUL lobectomy was performed. The patient had undergone an obstetric procedure 7 years previously in a make-shift refugee hospital in war-torn Ethiopia. The tube is postulated to have been introduced at the time of surgery and to have migrated trans-abdominally, eventually perforating both diaphragm and LUL. Review of the English literature of intra-parenchymal pulmonary foreign bodies shows this case to be unique.

Original languageEnglish
Issue numberSUPPL. 1
Publication statusPublished - 1 Dec 1999

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