Diagnosis of the case presented in the previous edition
Dany Jasinowodolinski; Gilberto Szarf; Nestor L Müller
Fleury Center for Diagnostic Medicine, São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP, Federal University of São Paulo), São Paulo, Brazil; University of British Columbia, Vancouver, BC, Canada
FOREIGN BODY (SURGICAL SPONGE) IN THE PLEURAL SPACE AFTER LEFT PNEUMONECTOMY
A 41-year-old male patient, with a history of a left pneumonectomy for the removal of a cystadenocarcinoma 3 years prior and surgery to remove metastases in the right lung 6 months prior. The patient reported back pain in the right dorsal region, with no other symptoms.
A diagnosis of a foreign body found in the postoperative evaluation is always extremely complicated from an ethical, as well as medico-legal, point of view. In most cases, this is an accidental finding, since the postoperative evolution is normal, and the patient is asymptomatic. Therefore, the diagnostic suspicion must be raised by the radiologist.
When the foreign body is metallic, such as a surgical instrument, the radiological confirmation is unequivocable. In the case of surgical sponges (which are the most common), the imaging aspect can vary widely, especially when the sponges have no internal metallic markers. The image often mimics that of a tumor, and is therefore referred to as a gossypiboma or textiloma. In this scenario, the radiological suspicion should be clearly communicated to the physician in charge of the case so that it can be further investigated and appropriate measures can be taken.
1. Suwatanapongched T, Boonkasem S, Sathianpitayakul E, Leelachaikul P. Intrathoracic gossypiboma: radiographic and CT findings. Br J Radiol. 2005;78(933): 851-3.
2. Sheehan RE, Sheppard MN, Hansell DM. Retained intrathoracic surgical swab: CT appearances. J Thorac Imaging. 2000;15(1):61-4.
READERS CORRECTLY DIAGNOSING THE CASE PRESENTED IN THE JULY/AUGUST 2006 ISSUE:
Alfredo Santana - Universidade de São Paulo - USP - São Paulo - SP
Artur Eugênio de Azevedo Pereira - Universidade de São Paulo - USP - São Paulo - SP
Ednei P. Guimarães - Hospital SOCOR - Belo Horizonte - MG
Paulo de Biasi - Instituto Nacional de Câncer - Rio de Janeiro - RJ
Reginaldo Bezerra Silva - Hospital de Messejana - Fortaleza - CE
Shirley Coletty dos Santos - Departamento Médico da Câmara dos Deputados - Brasília - DF
Publication in this collection
15 Mar 2007
Date of issue